Change in Transplant Policy Gaining Support
Doctors increasingly are using a controversial method of organ harvesting in which organs are removed from donors a few minutes after the heart has stopped beating, rather than after the patient has been declared brain dead, the Washington Post reports.
The approach, called donation after cardiac death, usually involves patients who have experienced brain damage. After the heart has stopped beating, doctors wait for a period of two to five minutes before harvesting organs.
Because the organ donation occurs before the patient is considered brain dead, DCD has come under attack for potentially putting the needs of organ recipients above those of the donor.
According to the Post, the procedure has raised "the disturbing specter of transplant surgeons preying on dying patients for their organs, possibly pressuring doctors and families to discontinue treatment, adversely affecting donors' care in their final days and even hastening their deaths."
However, Francis Delmonico of Harvard Medical School said DCD "is vital as an untapped source of organ donors." Delmonico noted that more than 95,000 U.S. residents are waiting for an organ transplant.
The Institute of Medicine has said DCD is ethical as long as hospitals have safeguards in place to ensure that families are not pressured into donating that include using an independent panel to review each case and separating the decision to donate from the decision to end care, the Post reports.
Michael DeVita, a professor of internal and critical-care medicine at the University of Pittsburgh, said, "We are saying that if it is feasible and we can do it in a way that does not harm the patient, then we should do this," adding, "We believe it's the right thing to do for the patients who want to donate and for those who need organs."
Gail Van Norman, an anesthesiologist and bioethicist at the University of Washington-Seattle, said, "It's worrisome when you stop thinking of the person who is dying as a patient but rather as a set of organs, and start thinking more about what's best for the patient in the next room waiting for the organs" (Stein, Washington Post, 3/18).