Imminent Death Donation: Ethical and Practical Policy Considerations

While the practice of organ donation after cardiac death has long been trending upwards in acceptance and use, it is still a highly controversial and practically inefficient method of organ procurement. One policy that has recently been proposed to try and alleviate some of the ethical and practical concerns with organ donation after cardiac death is the practice of imminent death organ donation. This type of live organ donation comes in patients at the end of their life who have decided to withdraw life-sustaining treatment, but still want to ensure that their organs are donated and not wasted, which isn't always the case with organ donation after cardiac death. This paper then gives some ethical and practical reflections and recommendations regarding the potential implementation of this controversial practice into regular transplant practice and policy.

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Organ Donation after Cardiac Death in the Pediatric Patient

10.1093/med/9780190678333.003.0070 ◽

2018 ◽

Author(s):

Caitlin D. Sutton ◽

David G. Mann

Keyword(s):

Brain Death ◽

Organ Donation ◽

Organ Transplantation ◽

Pediatric Patient ◽

Cardiac Death ◽

Organ Procurement ◽

Deceased Donor ◽

Donation After Cardiac Death ◽

Donor Organ ◽

Donor After Brain Death

The need for organ transplantation is ever increasing. Currently there are 115,000 people on the waitlist and the number is still growing. Organs that are transplanted may be obtained via a living or deceased donor. The organs may be obtained from a deceased donor after either brain death or after cardiac death. The majority of deceased donor organ transplants occur via deceased donor after brain death; however, deceased donor after cardiac death organ donation is increasing. This concept of organ transplantation can be quite difficult to discuss with families, therefore, the anesthesiologist and the entire care team must be knowledgeable and respectful regarding the patient’s and families wishes. The team should also be familiar with the overall process and organ procurement protocols of the institution. By having respectful, thoughtful, early discussions regarding the potential for organ donation, families will be able to make better informed decisions.

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Organ donation after cardiac death in amyotrophic lateral sclerosis

Annals of Neurology ◽

10.1002/ana.22525 ◽

2012 ◽

Vol 71 (2) ◽

pp. 154-156 ◽

Cited By ~ 6

Author(s):

Shahed Toossi ◽

Catherine Lomen-Hoerth ◽

S. Andrew Josephson ◽

Michael A. Gropper ◽

John Roberts ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Organ Donation ◽

Cardiac Death ◽

Donation After Cardiac Death ◽

Lateral Sclerosis

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Machine Learning to Support Organ Donation After Cardiac Death: Is the Time Now?*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000002639 ◽

2021 ◽

Vol 22 (2) ◽

pp. 219-220 ◽

Cited By ~ 1

Author(s):

Caitlin E. O’Brien ◽

Anna Noguchi ◽

James C. Fackler

Keyword(s):

Machine Learning ◽

Organ Donation ◽

Cardiac Death ◽

Donation After Cardiac Death

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Brain Death and Organ Donation

10.2310/tywc.1459 ◽

2018 ◽

Author(s):

Thomas I. Cochrane

Keyword(s):

Brain Death ◽

Organ Donation ◽

Cardiac Death ◽

Donation After Cardiac Death ◽

Donation After Brain Death ◽

Brain Death Determination ◽

Brain Dead ◽

American Academy Of Neurology ◽

Death Determination

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

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Donation After Cardiac Death Organ Procurement and Transplantation

Atlas of Organ Transplantation ◽

10.1007/978-1-4471-4775-6_2 ◽

2014 ◽

pp. 25-36

Author(s):

David J. Reich

Keyword(s):

Cardiac Death ◽

Organ Procurement ◽

Donation After Cardiac Death

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Organ Donation after Cardiac Death

Visceral Medicine ◽

10.1159/000064189 ◽

2002 ◽

Vol 18 (1) ◽

pp. 39-41

Author(s):

B.D. Shames ◽

A.M. D'Alessandro ◽

A. Krichevsky ◽

H.W. Sollinger

Keyword(s):

Organ Donation ◽

Cardiac Death ◽

Donation After Cardiac Death

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Organ Donation after Cardiac Death

Anesthesiology ◽

10.1097/00000542-200303000-00003 ◽

2003 ◽

Vol 98 (3) ◽

pp. 599-600 ◽

Cited By ~ 9

Author(s):

Robert D. Truog

Keyword(s):

Organ Donation ◽

Cardiac Death ◽

Donation After Cardiac Death

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Medical students’ attitudes and beliefs concerning organ donation after cardiac death

Resuscitation ◽

10.1016/j.resuscitation.2016.07.127 ◽

2016 ◽

Vol 106 ◽

pp. e53

Author(s):

Lukasz Szarpak ◽

Ali Rezaee ◽

Nahid Rezaee ◽

Jacek Smereka

Keyword(s):

Medical Students ◽

Organ Donation ◽

Cardiac Death ◽

Donation After Cardiac Death ◽

Attitudes And Beliefs ◽

Students Attitudes

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Join the Lone Kidney Club: incentivising live organ donation

Journal of Medical Ethics ◽

10.1136/medethics-2019-105999 ◽

2020 ◽

pp. medethics-2019-105999

Author(s):

Annet Glas

Keyword(s):

Informed Consent ◽

Organ Donation ◽

Living Donor ◽

Organ Procurement ◽

Organ Transplant ◽

Live Organ Donation ◽

Regulatory Frameworks ◽

Attractive Option ◽

Patient Groups ◽

Procurement System

Given the dramatic shortage of transplantable organs, demand cannot be met by established and envisioned organ procurement policies targeting postmortem donation. Live organ donation (LOD) is a medically attractive option, and ethically permissible if informed consent is given and donor beneficence balances recipient non-maleficence. Only a few legal and regulatory frameworks incentivise LOD, with the key exception of Israel’s Organ Transplant Law, which has produced significant improvements in organ donation rates. Therefore, I propose an organ procurement system that incentivises LOD by allocating additional priority points to the living donor on any transplant waiting list. I outline benefits and challenges for potential recipients, donors and society at large, and suggest measures to ensure medical protection of marginalised patient groups.

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