The recommendations from the 1997 IOM report, and the consensus and variations from the 1999 workshop are summarized in this chapter, and provide a range of options. Not every protocol will match every other protocol on every point. However, differences among protocols highlight points at which the grounds for variation should be thoroughly examined and explained.

The decision pathway involves both the patient care team and the donation team. Each team has separate but intersecting responsibilities regarding medications, procedures, arrangements for the family, withdrawing support and declaring death, and financial arrangements. Each decision point involves cooperation between the OPO and the hospital, to specify roles and responsibilities.

Workshop participants identified the central role of the OPO in facilitating the development of non-heart-beating organ donation activity. However, participants recognized that OPOs may find that they have few financial incentives and limited local support for developing this option. Hospital and physician support, adequate funding, and family requests encourage OPO efforts in this area.

Finally, the pathway suggests areas where full consensus has not been achieved at this time; where greater empirical certainty may alter protocol provisions; and where discussion, dialogue, and comparison have to continue.

Ongoing dialogue and consensus building can contribute to the further development and implementation of non-heart-beating donor protocols. These processes are discussed in the next chapter.



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