There are two protocols for donating vital organs after death. One involves brain death, and one involves removing life support, waiting for cardiac arrest, and then procuring organs after a few minutes.
This post deals with the latter. I have always thought that the organ procurement administrative processes were kept strictly segregated from decision making about whether to end life support. Apparently, I was mistaken. A reader sent me a 2012 discussion of protocols by the Organ Procurement and Transplantation Network (OPTN), in which the Organ Procurement Organization Comittee is asked to clarify the model rules for obtaining organs from a non heart-beating donor. First, the request as set forth in the report:
Explicitly endorse in the Proposal the longstanding ethical safeguard that the donor family not be approached about organ donation until the time at which a decision to withdraw life sustaining measures has been agreed to by the patient’s next of kin, as recommended by the Institute of Medicine. The proposed Requirements remove the important stipulation separating patient care from donation solicitations. Whereas previously the hospital’s primary healthcare team and the legal next of kin must have decided to withdraw ventilated support or other life-sustaining treatment before the patient is evaluated as a DCD candidate, under the proposed policy a patient may be evaluated as a DCD candidate prior to a decision by family members and caregivers, which ought to be free from external pressure. Gone is the crucial wall separating patient care from donation solicitations. Such undue influence on difficult decisions at a heart-wrenching time is ethically unacceptable.
That seems absolutely right to me, indeed, essential if we are to maintain proper ethics and sensitivity–and most particularly–family trust. After all, we don’t want anyone thinking about catastrophically ill or injured patients as organ systems rather than as patients.
And now, the chilling answer from the Committee:
The OPO Committee disagrees with the position that a patient may not be evaluated as a DCD candidate prior to a decision by family members and caregivers to withdraw life sustaining measures, or the position that a donor family not be approached about organ donation until the time at which a decision to withdraw life sustaining measures have been agreed to…The timely referral of a potential organ donor occurs prior to family knowledge of donation options for two primary purposes: 1) the evaluation of a patient as a potential organ donor can be facilitated without OPO communication with the family, and 2) the patient may have already been registered as an organ donor, which requires no further authorization by a surviving family or caregiver.
By not allowing for an OPO’s evaluation for donor candidacy prior to a decision to withdrawal, the health care system may expose families to the following misrepresentations: 1) to imply that their loved one is not a donor candidate, when in fact they might be a candidate; 2) to cause a delay in carrying out patient withdrawal procedures as agreed to by a surviving family, but prior to OPO involvement (The 2006 version of the UAGA allows for an OPO to “conduct any reasonable examination necessary to ensure the medical suitability.” The UAGA has been enacted in 44 of 50 states and legislation pending in three states;
HT: B.A. Olevitch