Organ Donation: Who, How,Why and also What are the Ethics? (1)

The need by the sick for donated vital organs far exceeds the supply. Through the years the supply was provided primarily by certain organs obtained from freshly deceased patients and from live donors who altruistically donated a kidney, part of a lung or part of a liver as example. For the most reliable organs to be obtained after transplantation into a sick patient, the organ needs to have maintained good circulation and oxygenation and therefore should be removed as soon as possible after death or better while the donor is alive as in the case of the live volunteer.

In order to increase the numbers of organs available, the concept of brain death was developed. This condition is identified if there is neurologic evidence of complete and irreversible absence of function of the whole brain including the brain stem where respiration and cardiovascular control is located amongst other functions. A brain dead patient is therefore considered dead and even though the heart may still be beating for a while and while respiration is being maintained by machine, organ procurement can be ethically and legally begun with the previous permission of the patient and/or the family.

Finally, another source for organs has gained popularity given, as stressed by ethical consensus in recent years, that care is taken to conform to strict ethical boundaries. This source is termed non-heart beating organ donation. The valuable aspect of this source is that the donor patient can be kept alive until the surgeons are ready to procure the organs and therefore the organs will be in better condition than from a patient whose death was spontaneous and maybe unwitnessed. The non-heart beating organ source is a patient who is terminally ill and by advance directive has declared that he or she did not want to be maintained on life-support if there was no hope for recovery and the either the patient or family agreed to an organ donation. In this case, even without organ donation, the patient’s life-support such as ventilator and blood pressure maintaining medications would be at some point removed and the patient would then die. In the case of organ donation, the point in time when the life-support is removed is determined when the surgeons are ready to procure the organs. While the surgeons are standing by, the life-support is terminated and then the patient is observed for the heart to stop beating. When this occurs, there is a wait of from 2 to 5 or even 10 minutes and if the heart does not resume, the patient is considered dead and the operation to obtain the organs begins. If the patient’s heart continues to beat, the patient is usually watched for another hour and if no cardiac arrest has occurred by then, any attempt of procurement is abandoned and the patient is returned to the ward for comfort care until death occurs.

I will discuss in my next posting some of the ethical issues involved with organ donation including brain death and the non-heart beating donation. Can you think of some of them yourself? ..Maurice.