Not brain-dead, but ripe for transplant

[gwenith]

In June, Ottawa Hospital in Canada announced its first organ transplant in recent history from a patient who hadn't been classified as brain-dead, but whose heart had stopped - so-called "donation after cardiac death" (DCD). By switching to this definition of death for transplant purposes, doctors hope to increase the number of healthy organs available and the number of potential donors from which they can be harvested. For example, the Australian Health Ethics Committee (AHEC) is considering recommending legislation to enable more DCDs, as part of a drive to turnaround Australia's flagging organ donation rates. A similar shift is taking place in the US, where a limited number of DCDs already take place. There, the number of DCD kidney transplants has increased fivefold since 1995 to over 500 in 2004, and numbers are expected to increase sharply over the next decade.

http://www.newscientist.com/article/mg19125633.400-not-braindead-but-ripe-for-transplant.html

This I feel may be a disturbing trend and I would like to see more ethics investigation prior to going down this road.

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

I just wanted to point out that before we had "brain death" criteria, the original donation for transplantation came from cadaver organs from the 1960'ish, or non-beating heart donation. DCD came back into favor because of the limited supply of organs. DCD has been a great way to enable a family that wants to "gift" organs that would otherwise be unable if they had to wait for brain death to occur (which is terribly grueling for families who sit and wait to have it confirmed that yes, their loved one is truly gone).

We take our patients into the OR as a planned procedure. We extubate the patient having the MSO4 in hand in case they happen to struggle for air, it is not an excessive amount. The family is able to be with the patient in the OR right up until the family is ready to leave and the gifting begins. If the patient does not die within two hours, the patient is transferred back to the critical care unit and then pallative care begins.

Families have been very grateful for the process. We even had one family that had a trauma patient who did not qualify for BDC, but wanted to donate so badly that they transferred their loved one to another hospital that did the DCD (before we had our policy in place).

[JW-RN]

I just wanted to point out that before we had "brain death" criteria, the original donation for transplantation came from cadaver organs from the 1960'ish, or non-beating heart donation. DCD came back into favor because of the limited supply of organs. DCD has been a great way to enable a family that wants to "gift" organs that would otherwise be unable if they had to wait for brain death to occur (which is terribly grueling for families who sit and wait to have it confirmed that yes, their loved one is truly gone).

We take our patients into the OR as a planned procedure. We extubate the patient having the MSO4 in hand in case they happen to struggle for air, it is not an excessive amount. The family is able to be with the patient in the OR right up until the family is ready to leave and the gifting begins. If the patient does not die within two hours, the patient is transferred back to the critical care unit and then pallative care begins.

Families have been very grateful for the process. We even had one family that had a trauma patient who did not qualify for BDC, but wanted to donate so badly that they transferred their loved one to another hospital that did the DCD (before we had our policy in place).

this is almost EXACTLY how our policy reads...

I sit on the Organ Donation Committee of our health system (as the NSICU rep) and can tell you that shaping this policy was VERY difficult and it can be even more difficult to execute, but it is definitely worth it!

[MadJackie]

For a few years now, the UK has been performing non-heart organ donation (NHBOD), and I fully support it. I really cannot see the problem with it. The procedure is obviously not the same as "routine" organ donation (heart beating) as the patient has to be certified brain-stem dead for this. Whereas for NHBOD, the patient is still going to die, and the situation is hopeless, BUT the patient does not fit the criteria for being brain-stem dead.

Many of our relatives approach us regarding organ donation, but prior to NHBOD, many relatives were left feeling frustrated because they couldn't give this wonderful gift as their relative didn't fit the criteria.

The UK Translant Team are independent and play no part in the decision-making process of the patients treatment withdrawl. They are only contacted after decisions have been made.

There are thousands of people waiting for organs, and if I am dead or if someone I love dies, the organs are no longer needed. I know it would make me feel a little better if I knew the organs of my loved ones are "living on" in someone else. Or mine are living in someone else after my death.

It's the free gift of life.