Non-Heart-Beating Organ Transplantation Medical and Ethical Issues in Procurement (1997) / Chapter Skim
Currently Skimming:
4 The Modern Non-Heart-Beating Donor
4 The Modern Non-Heart-Beating Donor
Pages 23-32
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 23... ...
As noted earlier, the NHBD is a donor whose death is defined by "irreversible cessation of circulatory and respiratory functions" as opposed to "irreversible cessation of all functions of the entire brain, including the brainstem" (Uniform Determination of Death Act, 12 Uniform Laws Annotated 320 t1990 Supply. Organs recovered from such a donor cannot be ideally suited for transplantation because cardiopulmonary death means that organs will not con 23
|
From page 24... ...
This kind of NHBD the controlled NHBD is the one that most closely simulates the ideal conditions for organ recovery which exist with organs procured from heart-beating cadaver donors; that is, it is the donor with the shortest time between absence of circulation and removal of organs, and it is the most common kind of NHBD in the United States. These donors are controlled because the timing and thus the process of donation are controlled through the timing of life support.
|
From page 25... ...
The contribution of kidneys retrieved from uncontrolled NHBDs to the kidney supply is fortunate because this is the organ most in demand (D'Alessandro et al., 1995a; Kootstra, 1997~. On the other hand, in terms of addressing the supply shortage, it is unfortunate that uncontrolled donors with their limitations are potentially the largest category of donors (Light et al., 1996; Nicholson, 19969.
|
From page 26... ...
These are the kinds of pressures that have justified "presumed consent" laws in many countries, which authorize, unless there is notice to the contrary, nonconsensual organ perfusion or even in some cases organ removal while awaiting consent for donation (Veatch and Pitt, 1995~. In the United States, the District of Columbia has a law that allows perfusion and cooling without consent and a successful program that utilizes this statutory authority to procure uncontrolled NHBDs (87 Stat.
|
From page 27... ...
Ellison, personal communication, June 27, 1997) in Tables 4.1A and 4.1B suggest a baseline of a small number of uncontrolled NHBDs.
|
From page 28... ...
Data subject to correction based on future data submission or correction. The results of transplantation reported since 1994, the first year that UNOS began keeping separate statistics on controlled and uncontrolled NHBDs, are shown in Table 4.2, which, because of small numbers, includes only kidney and liver data.
|
From page 29... ...
In Table 4.3 total results of liver transplants using NHBD livers are dramatically worse than liver heart-beating donor results, and since uncontrolled NHBD liver results in Table 4.2 are slightly better than total results, a small group of more successful controlled donor grafts is not hidden in the total. Because of insufficient numbers, these data are preliminary indications only, but they tend to support the promise of NHBD kidney transplantation, perhaps with slightly reduced graft survivals; to confirm that fewer organs per donor are recovered from NHBDs, and these are mostly kidneys; and to suggest that further improvements in liver transplantation with NHBD livers could, and probably will be achieved.
|
From page 30... ...
Rates of delayed kidney graft fimction have been high, particularly in transplants using organs from uncontrolled NHBDs, as noted earlier. These results should be compared both to results Dom the best types of donors and to the hazards and the economic and human costs endured by patients on the waiting list or by the set of patients who because of implicit rationing are not formally listed.
|
From page 31... ...
, wider acceptance of expanded donor criteria including emotionally related living donors, more organs retrieved per donor, research to improve organ use (e.g., screening methods for viability to enhance use of good organs and minimize use of organs that are not in good condition) , increased research in general to improve transplantation success rates and reduce retransplantation, and continued experiments at the state alla ultimately, national level, (e.g., registries, required notification of hospital deaths to OPOs, or perhaps extension of required requests to potential category III NHBDs)
|
From page 32... ...
32 NON-TIEART-BEATING ORGAN TRANSPLANTATION ever, best efforts should be made to develop reasonable solutions. At the same time, there should be a realistic understanding of the limitations of the NHBD given current technology and procedures.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.