'Dead Donor Rule' Still Lives in New Organ Transplant Policies

In June 1995, Sue McVey Dillon got the phone call every mother dreads: Her 14-year-old son Michael was being rushed into surgery for brain trauma after he plunged to the ground when a makeshift rope swing snapped.

The Chester County, Pa., boy who loved rock climbing, girls, track and fishing was "one of those kids who went to bed at night recharging for next day," Dillon said. "He was into everything."

With a body temperature of 108 and little brain activity, Michael was put on ice -- and life support. "As a mother, you panic," she said. "I knew it wasn't good at all."

Learning the brain damage was irreversible, the family spent an agonizing weekend asking "a million questions" and consulting a trusted family doctor. Ultimately, the family decided to withdraw Michael from life support and asked about organ donation.

Michael was the first patient in Philadelphia's Gift of Life program to donate an organ after cardiac death -- even though he was not yet brain dead. The ventilator was pulled, his heart stopped, and several minutes after death, Michael's liver, two kidneys and two corneas were removed to help five people.

Organ donation by cardiac death -- known as DCD -- is not new, but it is gaining momentum nationwide at a time when a record number of adults and children are waiting for kidney and liver transplants.

Cardiac Death Donations Growing

DCD procedures have grown to 605 in 2006, up from 268 in 2003, according to the United Network for Organ Sharing (UNOS), which oversees organ procurement through 58 regional centers.

For the last 30 years, brain death has been used to determine when a life ends and organ donation could begin. But today, hospitals are using cardiac death as a marker so they can meet a growing demand for organs.

The National Academy of Sciences' Institute of Medicine has ruled DCD is ethical as long as donor care and transplantation are separate and surgeons wait at least five minutes after the heart stops. Now UNOS and federal health officials are recommending that all hospitals decide whether to allow DCD.

This shift in protocol could be a boon to the 95,000 people waiting for transplants, but it has alarmed medical ethicists who say a hospital's first priority should be end-of-life care and not organ retrieval.

"There are split loyalties, and we want to make sure that the donor's interest is put front and center," said Joan McGregor, director of the bioethics program at Arizona State University. "Doctors caring for dying patients shouldn't push the clock."

Increasing the Donor Pool

With only 13,000 brain deaths a year for medical conditions like gunshot wounds, aneurysms and cardiac arrests, the new DCD protocol could increase the annual number of potential donors by 15,000 to 20,000, said UNOS spokesman Joel Newman.

The need for organs -- particularly kidneys and pancreases -- has been accelerated by an epidemic in liver cancer related to HIV and Hepatitis C and to diabetes and hypertension, according to Douglas Hanto, a transplant surgeon at Beth Israel Deaconess Medical Center in Boston.

In 1996, about 18,000 patients were added to transplant wait lists. Just last year, about 30,000 were added, Hanto said.

With the rising demand, extra donors from DCD protocols would be a great help to patients who need organs. Although 85 percent of all Americans support organ donation, there were only about 8,000 who donated organs after death last year, Newman said.

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