1. family consent for premortem cannulation;

  2. conflict-of-interest safeguards;

  3. determination of death (in controlled non-heart-beating donations) by cessation of cardiopulmonary function for at least five minutes by electrocardiographic and arterial pressure monitoring; and

  4. family options (e.g., attendance at life support withdrawal) and financial protection.

Following the publication of this report, the Department of Health and Human Services (DHHS) contacted the Institute of Medicine with a request for an effort designed to facilitate the adoption by all OPOs of protocols regarding non-heart-beating organ donation. In response to this request, the IOM designed a dissemination, communication, and consensus effort, sponsored by the Division of Transplantation at the Health Resources and Services Administration (HRSA). The goals of this study were defined as follows (Statement of Task, Appendix A):

  1. To familiarize all relevant parties with the 1997 IOM report.

  2. To identify obstacles to implementing its recommendations.

  3. To facilitate the development of organ procurement practices consistent with the principles and recommendations articulated in the 1997 IOM report.

These tasks were defined as necessary steps towards the ultimate goal of the voluntary adoption of non-heart-beating donor protocols. The need for further efforts towards this goal was identified during the study.

The study was guided by a committee of experts in ethics and law, organ procurement and transplantation, and patient care. The central activity for the study was a national workshop on non-heart-beating-donor protocols held in Washington, D.C., on May 24 and May 25, 1999 (Appendix B). Participants in the workshop included care providers, organ procurement professionals, and families who supported non-heart-beating donation. In three roundtable discussions, workshop participants compared protocol content from six active non-heart-beating-donor programs, described the process of protocol development, and identified challenges encountered in implementing these protocols. Participants also reviewed and discussed work commissioned by the committee in preparation for the workshop and the report. This commissioned work included an expert paper on the determination of death (Youngner et al., 1999), a model for evaluating the outcome of non-heart-beating organ donation (Chapter 6), and a model for a family information brochure on non-heart-beating donation (Appendix E).

Following the workshop, the committee formulated seven recommendations for developing and implementing non-heart-beating-donor protocols. These recommendations were based on the findings and recommendations from the 1997 IOM report and consensus achieved among participants at the national work-

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