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Non-Heart-Beating Organ Transplantation: Practice and Protocols
Questions About Donation
What further data are necessary in order to develop consensus on the declaration of death following the withdrawal of life-sustaining treatment and the cessation of cardiopulmonary function?
How can these data be collected in ways that are scientifically reliable but noninvasive and sensitive to donor patients and their families?
How do families respond to non-heart-beating donation? Anecdotal evidence supports the conclusion that some patients and families pursue this option eagerly and are profoundly disappointed if it cannot take place. However, there are no studies that compare the experiences of non-heart-beating donor families with those who choose not to donate in this way or with those who donate following death by neurological criteria.
What impact do the withdrawal of life-sustaining treatment and rapid organ recovery have on family leave-taking and on subsequent coping with grief and loss?
Questions About Transplantation
What impact will non-heart-beating organ donation have on the shortage of organs for transplantation? Suggestions that organs from non-heart-beating donors can increase the supply of organs by as much as 20% (D’Alessandro et al., 1995; Koogler and Costarino, 1998; Lewis and Valerius, 1999) are balanced by suggestions that non-heart-beating donation may compromise public trust and thus reduce overall donation rates (anecdotal). With a total of approximately 150 non-heart-beating donors comprising less than 1% of donors in the past two years, the actual impact on organ donation cannot yet be assessed.
How much more costly is the recovery of organs and tissues from non-heart-beating donors than the recovery of organs and tissues following death by neurological criteria (Jacobbi et al., 1997; Butterworth et al., 1997)? Why are the costs higher, and what might be done to offset these higher costs?
Are the data on the outcomes of transplantation with organs from non-heart-beating donors adequate to persuade Organ Procurement Organizations (OPOs) and transplant surgeons of the value of non-heart-beating donor organs? In spite of published reports of favorable outcomes following non-heart-beating organ transplantation (Yong et al., 1998), workshop participants reported continuing reluctance to use these organs due to concerns about quality and long-term transplantation outcomes. This reluctance stems from the limitations in the published data: small numbers and many confounding variables.
How do different ways of handling recovered organs affect organ viability and transplant outcomes? Surgeons and OPOs employ a number of methods to promote organ viability and good transplant outcomes. These methods include in situ cold preservation, the use of anticoagulants and vasodilators, and “pumping” kidneys following removal. As suggested during the workshop, these