Non-Heart-Beating Organ Transplantation Medical and Ethical Issues in Procurement (1997) / Chapter Skim
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Appendix B
Appendix B
Pages 75-88
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From page 75... ...
Potts, Jr., Principal Investigator Federal Government and Political Considerations Judith Braslow, Director, Division of Transplantation, Health Resources and Services Administration UNOS, Procurement, Allocation, and Data Collection Lawrence Hunsicker, President, United Network for Organ Sharing Organ Procurement Issues in the Context of the Non-Heart-Beatin~ Donor Phyllis Weber, Executive Director, California Transplant Donor Network Laurie Garretson, Executive Director, New Mexico Donor Program Scientific Issues and Medical Perspectives Harold Helderman, President, American Society of Transplant Physicians Paul Terasaki, Professor of Medicine and Surgery, University of California at Los Angeles Transplant Coordination Mark Reiner, Past President, North American Transplant Coordinators Organization 75
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From page 76... ...
Many organ procurement organizations (OPOs) are examining the potential of non-heart-beating donation programs to address the organ shortage problem.
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From page 77... ...
Maintaining potential donors on life support can be expensive. Hospitals may be encouraged to obtain permission for removal of life support without awaiting a determination of brain death.
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From page 78... ...
would be so long that many patients would never be listed. Organ Procurement Issues in the Context of the NHBD Phyllis Weber of the California Transplant Donor Network and Laurie Garretson of the New Mexico Donor Program discussed the day-to-day realities of procuring organs from NHBDs and the issues that OPOs face in initiating NHBD programs.
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From page 79... ...
There is consistency among OPOs in some provisions of NHBD practice, but there are essentially no standards in some areas, such as where in the hospital removal from life support and cannulation procedures take place, what medications are given to donors and when they are administered, and when cannulation is performed. These areas of inconsistency put public trust at risk, but any standards developed should allow flexibility provided this does not compromise public support for NHBD programs.
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From page 80... ...
However, many of the data show that in the case of controlled NHBDs, this does not seem to affect graft and recipient survival rates negatively compared to heart-beating donors. Uncontrolled NHBDs are associated with a considerably higher rate of delayed graft function, but ultimately, survival of these grafts is not substantially worse than heart-beatin~ donor graft survival.
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From page 81... ...
Terasaki. Transplant Coordination Mark Reiner, past president of the North American Transplant Coordinators Organization (NATCO)
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From page 82... ...
However, it is currently used to identify OPOs with particularly successful donor programs. These programs have been studied to determine if some of their practices could be applied nationwide for better national procurement.
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From page 83... ...
This routine referral law includes a fine for hospitals failing to report deaths to the OPO and has resulted in a significant increase in donors, many of them NHBDs. Illinois passed the "live and learn" legislation in 1993 that dedicated $2 million annually to public education on donor issues.
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From page 84... ...
Professional education about the care of potential donors and the legal and ethical issues involved is crucial as well. Some standardization in the form of medical practice guidelines about donor care and the declarations of death could prove essential for avoiding conflicts of interest and improving public trust.
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From page 85... ...
NHBDs are currently only a small percentage of cadaver donors, but due to ongoing changes in medical practice, this percentage could increase quickly. For example, the withdrawal of life support is often happening within the first 24 to 48 hours after the critical event and before the patient can meet brain death cri
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From page 86... ...
These include the use of femoral catheters, administration of medications, arterial monitoring to reliably determine death, and even the fact that death usually takes place in the OR so that procurement can begin immediately. Are there ethical barriers to these interventions if they are not for the benefit of, or might even be harmful to, the dying patient?
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From page 87... ...
The goal in this case is organ procurement that can be realized within ethically acceptable limits. This reflects better the direction of the discussion of the pressing need for organs and suits better the accepted assumption that increasing organ donation is a worthy and ethical objective.
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