others out of their own loss (Bartucci, 1987; Batten and Prottas, 1987; DeJong et al., 1998; Pearson et al., 1995). Family participants in the workshop confirmed this motivation for organ and tissue donation from their own experiences.

Second, recent HCFA regulations require that all deaths and impending deaths be referred to the local organ procurement organization (OPO), and that the option of organ and tissue donation be offered by a trained requester (42 U.S.C. Sect. 482.45). These regulations are in the process of being implemented. As implementation proceeds, these regulations are expected to increase substantially the number of patients that OPOs evaluate as potential donors (Ehrle et al., 1999; McCoy and Argue, 1999; Nathan et al., 1991). Comprehensive evaluation of potential donors should include the option of non-heart-beating donation, and whether the family might wish to consider this option. As is the case with any decision to donate organs and tissues, the decision about non-heart-beating donation rests with the patient and family.

Third, non-heart-beating donation has the potential to contribute substantially to the supply of organs and tissues for transplantation. Reports in the literature suggest that non-heart-beating donation might contribute 20% or more to the supply of kidneys (Koostra et al., 1991; Koogler and Costarino, 1998; Lewis and Valerius, 1999), and an undetermined amount to the supply of other solid organs (e.g., the liver and the pancreas) (D’Alessandro et al., 1995; Yersiz et al., 1999). Although this study follows a patient and family-centered approach to donation that emphasizes the needs and wishes of donor patients and families, the needs of critically ill potential recipients are an important social and medical priority as well, and warrant efforts to increase the supply of organs and tissues.

The development of non-heart-beating donor protocols is a cooperative effort among OPOs, hospitals, health care professionals, and communities. OPOs act as leaders, intermediaries and facilitators, assisting hospitals with development of protocols or providing OPO protocols to smaller hospitals with limited numbers of referrals and limited resources for protocol and staff development. Hospitals can initiate or facilitate non-heart-beating donation by developing their own non-heart-beating donor protocols. In addition, hospital protocols for the termination of life-sustaining treatment and the provision of palliative care are absolute prerequisites for non-heart-beating donation and for high-quality end-of-life care.

NON-HEART-BEATING TRANSPLANTATION: BACKGROUND

History

The procurement and transplantation of organs from non-heart-beating donors represents both a new practice and a return to a former practice in organ transplantation. During the early years of organ transplantation, all organs for transplantation were obtained from living kidney donors or from patients de-



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