And Now: Under New Guidelines Surgeons Won’t Have To Wait To Make Sure A Heart Has Stopped Beating Before Harvesting Organs

Surgeons won’t have to wait to make sure a heart has stopped beating before harvesting organs under new guidelines (Daily Mail, Sep. 20, 2011):

Surgeons retrieving organs to be transplanted just after a patient’s heart has stopped beating will no longer have to wait to make sure it doesn’t start up again if new proposals are adopted.

At present when doctors are retrieving organs they have to wait at least two minutes to ensure it doesn’t spontaneously start again.

Critics now fear seriously ill patients could be viewed more like tissue banks than sick people if the plans to change rules about organ donation go ahead.

There is currently a ban on considering anyone to be a potential donor before doctors and family members have independently decided to stop trying to save them.

That is poised to be eliminated if the plans by the group that co-ordinates organ allocation in the United States are adopted.

The proposed changes by the United Network for Organ Sharing, the Richmond nonprofit organization that coordinates organ donation under a contract with the federal government, are part of the first major overhaul of the 2007 guidelines governing “donation after cardiac death,” or DCD, which accounted for 6% of the 28,000 organs transplanted in 2010.
Champions of the proposals claim the changes strengthen the transplant system because they align the rules with other regulatory bodies and better ensure that the wishes of donors and their loved ones are honoured without sacrificing necessary protections.

Charles Alexander, a former president of UNOS, said: ‘The ultimate goal is to facilitate the dying wishes of patients who wish to be donors and save the lives of the 112,000-plus patients who are in need. We are always very aware of our public trust.’

Critics, however, say the move heightens the risk that potential donors will be treated more like tissue banks than like sick people deserving every chance to live, or to die peacefully.

Michael A. Grodin, a professor of health law, bioethics and human rights at Boston University, said: ‘This is another step towards this idea of hovering, hovering, hovering to get more organs. The bottom line is that they want to do everything they can to increase organ donation.’

The 16-page proposal has resurrected the controversial debate over what it means to be dead.

It was drafted over a year by the 22-member UNOS organ procurement organization committee.

The UNOS board will convene in November in Atlanta to finalize the revisions, which include officially shifting the guidelines from ‘model elements’ to ‘requirements.’

‘We want the process to happen the way it’s supposed to happen to avoid any questions or problems,’ Alexander said.

Donation after cardiac death involves surgeons taking organs within minutes of respirators and other forms of life support have being cut off from patients who still have at least some brain activity.

DCD had been the norm for organ donors before ‘brain death’ became the standard in the early 1970s. Since then, most donors have been brain-dead.

But as the number of people needing transplants rose, doctors in the 1990s began reviving what was then called ‘non-beating heart’ donation.

DCD has become a growing source of organs as the gap between the number of patients waiting for transplants and the number of available organs has widened.

About 6,000 Americans die each year while waiting for donated organs. There were almost 14,000 transplants between January and June this year with just under 7,000 donors.

The current waiting list for transplants stands at more than 112,000 people.

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