Not brain-dead, but ripe for transplant

[gwenith, BSN, RN]

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.

[PANurseRN1]

deleted

[fergus51]

I don't see the problem. If your heart isn't beating and isn't going to start again, aren't you dead? I wouldn't have a problem with them taking my organs after that point.

[gwenith, BSN, RN]

I think some of my objections stem from the time to decide Cardiac death. Although at present it seems 10 minutes is being considered before irreversable cardiac death in some time periods as low as 2 minutes are being suggested.

[fergus51]

OK. I guess it still wouldn't bother me much if we know the heart isn't going to start again (as in the patient is a DNR removed from the vent or something). I don't know anyone who has spontaneously come back to life after their heart had been stopped for 10 minutes.

[kindaquazie]

Hi,

We do this procedure at my hospital and it is very difficult and very rewarding. The process is usually initiated by the family members. For instance, there is no hope for Jane Doe to ever recover and she needs agressive life support. However, she did not advance to brain death for a variety of reasons. The family has decided to withdraw support, and the patient will likely die within minutes as she is requiring ventilatory support and pressors. However, she is not brain dead and therefore cannot be an organ donor as she had wished. The family is devestated. But, there is a ray of hope to bring meaning to the death of this young girl, DCD. The family is grateful, the organs are donated, and several other people get to lead much better lives.

Each case should be followed by a debriefing for those involved. Each case is extremely individual. But for families, it is a blessing. Can you imagine praying one day for your son to live, and the next that his brain will herniate so he can be an organ donor. This gives families a real sense of meaning when it is time to withdraw support.

[GardenDove]

I also find it a disturbing trend. There is also a market in some countries for questionably obtained organs, such as those removed from political prisoners. Some will sell kidneys for money, which I hope will remain illegal in the U.S. All of these things are ripe avenues for exploitation and abuse, imo.

[AliRae]

We've done one at our hospital thus far, I believe. I think it's something like the first cut for harvest has to be made 10 (maybe a little more, but it's a low number) minutes after the heart stops. For us since we couldn't predict exactly when that would be, that involved a team RUNNING down the hall with a bed, splashing the kid with betadine and cutting as quickly as they could. I think it's good to harvest as many organs as possible, but it just seems so harsh.

[subee, MSN, CRNA]

I think some of my objections stem from the time to decide Cardiac death. Although at present it seems 10 minutes is being considered before irreversable cardiac death in some time periods as low as 2 minutes are being suggested.

And what is the difference that your alternative would make? I mean, what difference does it make to the patient? Is there any chance that changing the time of cardiac death would contribute to worsening thepatient's condition? I'm not being snide - I'm really asking. I KNOW it makes you uncomfortable but why?

[CRNI-ICU20]

I hope they remember to check the EKG in two leads!!

[GardenDove]

I don't like the term 'harvest' at all. It strikes me as macabre. Ugh, I picture a room full of people on life support, disembodied brains, and Frankensteinian doctors with wild-eyed looks in their eyes, ready to bring in the harvest.

[SouthernLPN2RN, MSN, RN, APRN, NP]

We recently had an inservice on this. Supposedly, the vent has to be off and the pt down for 5 minutes, then restart vent or reintubate while in OR.