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News of the Day ... In Perspective

3/19/2007

Donation after cardiac death expanding rapidly

To help cope with the shortage of organs for transplantation, the United Network for Organ Sharing and the Joint Commission on Accrediation of Healthcare Organizations (JCAHO) are requiring hospitals to decide whether to accept the practice of “donation after cardiac death” (DCD). Hospitals are scrambling to develop policies.

DCD usually involves patients who have suffered brain damage but are not brain dead.

Once decisions are made to terminate life support and to donate organs, the donor is moved to an operating room, where a transplant team waits for the heart to stop. Five minutes later (or three, or two—or 75 seconds in infants), surgeons remove the heart.

Donors may receive morphine, diazepam, or other drugs to make sure they do not suffer as life support is withdrawn. Sometimes a large intra-arterial line is inserted so heparin can be injected to help preserve the organs.

DCD supporters argue that donors meet the legal definition of death “because there is no intention of reviving them,” and that there is no evidence that anything done to the donors hastens their death.

The number of DCDs more than doubled from 268 in 2003 to at least 605 in 2006.

The National Academy of Sciences Institute of Medicine has decided that DCD is ethical as long as “strict guidelines are followed.”

Others object. “The person is not dead yet,” stated Jerry A. Menikoff, an associate professor of law, ethics, and medicine at the University of Kansas.

When surgeons in the 1990s resurrected what was called the “non-beating heart” donation, which had been standard before the concept of “brain death” became accepted in the 1970s, some critics said it was tantamount to murder.

Many fear that the practice will pressure doctors and families to discontinue care. One hospital chain that adopted DCD instituted a moratorium because of concerns that the local organ bank was becoming too aggressive (Rob Stein, Washington Post 3/18/07).

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