Hospitals are being encouraged to adopt new organ donation policies stating whether organs are to be harvested after brain death or cardiac death, according to the United Network for Organ Sharing, which oversees organ procurement, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits hospitals.  The recommendation is creating intense ethical debates, especially in children’s hospitals, as medical centers rush to develop policies.

After thirty years of donations occurring after a person’s brain activity has ceased, many wonder why the sudden push for new protocols.  The numbers may speak for themselves:  There are 95,000 people awaiting transplants, with only 13,000 brain deaths a year.  Switching to new DCD protocols could increase the annual number of potential donors by 15,000 to 20,000, relayed the National Academy of Sciences’ Institute of Medicine spokesman Joel Newman.

“Donation after cardiac death” (DCD), occurs when a patient’s heart stops beating, typically about 2-5 minutes after the last beat.  However, Denver Children’s Hospital waits 75 seconds.  The longer hospitals wait to remove organs, the greater the chances that the organs will not be useable.  Despite the risk of losing viable organs, doctors wait a few minutes for removal because a heart can restart spontaneously.   

Procedure:  Organ-banks typically approach family members of patients after they have decided to remove a ventilator or other life-sustaining treatment.  Once selected as a candidate for DCD, if the candidate’s heart does not stop quickly, usually within an hour, the organ donation procedure is aborted and the patient is taken back to his or her room until they die.

History:  DCD was the norm before brain death became the standard for pronouncing death in the early 1970s and surgeons began keeping the donor’s body functioning with life-support machinery until transplantation could begin.

Some experts believe that DCD opposes the definition of death: “The person is not dead yet,” said Jerry A. Menikoff, an associate professor of law, ethics and medicine at the University of Kansas. “They are going to be dead, but we should be honest and say that we’re starting to remove the organs a few minutes before they meet the legal definition of death.”

Legal definition for death …Most states require “irreversible cessation of all functions of the entire brain, including the brain stem.”

The National Conference of Commissioners on Uniform State Laws in 1980 formulated the Uniform Determination of Death Act (UDDA). It states that: “An individual who has sustained either

(1) irreversible cessation of circulatory and respiratory functions, or

(2) irreversible cessation of all functions of the entire brain, including the brain stem is dead.

A determination of death must be made in accordance with accepted medical standards.”

This definition was approved by the American Medical Association in 1980 and by the American Bar Association in 1981. Today all fifty states and the District of Columbia follow the UDDA as a legal standard of death.