to organs, provide organ-conserving interventions as necessary, discontinue breathing and circulatory support when a proper decision and proper consent to do so has been obtained to allow the irreversible cessation of cardiac and pulmonary function so as to meet the legal standard of death, and then begin preserving and removing organs as soon as possible before they deteriorate. This tightly scheduled management of the donor patient and the transplantable organs must, as noted, satisfy a number of important ethical principles, including the dead donor rule, respect for family wishes, prohibition against euthanasia, and informed consent.
To some extent in this country, and more often in Europe, transplantation involves a category of NHBDs who are not controlled by technological support of respiration and heart function. These individuals (uncontrolled NHBDs) have suffered cardiopulmonary arrest as a result of severe illness or injury just before admission or during their hospital stay. This "uncontrolled" event dictates great speed in retrieving organs, early organ preservation interventions, or sequences of resuscitation efforts that start and stop depending on the status of the donor and the transplantable organs. This process must meet ethical principles similar to those for controlled NHBDs. Because the medical and ethical issues and the problems of all NHBDs, controlled or uncontrolled, are similar in so many essential ways, this report should and does examine all categories of NHBD.