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

"Organ donation is an issue of public trust," Newman said. "When life begins and when life ends are vital questions. But there is another element -- this is a procedure that yields benefit to someone else."

Time Is Critical in Retrieving Organs

In DCD situations, the approach usually involves patients like Michael, who have suffered irreversible brain damage from an accident or a stroke. After family members have made the difficult decision to discontinue a ventilator or other life-sustaining treatment, organ-bank representatives talk to them about donation.

The patient is allowed to die naturally. With the consent of family members, anti-blood-clotting drugs are administered to prevent organ demise, and pain medication is never withheld, doctors say.

The amount of time doctors wait to begin retrieving organs is critical because the viability of the organs depends largely on the length of time it takes a patient to die. After 30 minutes a liver is unusable; a kidney can survive only an hour.

Even though the number of DCD cases is small, an ethical debate centers on the wait time after a donor's heart has stopped beating and on the quality of care the patient is given on his or her deathbed.

There is even some disagreement on when doctors can conclusively determine when a patient is dead.

The heart can auto-resuscitate after withdrawal from life support, and some doctors have reported a so-called "Lazarus Syndrome" in which the heart can restart after stopping for as long as 10 minutes, according to medical ethicist McGregor.

Although these patients ultimately die, critics wonder whether the patients, who still have some brain activity, can still feel pain.

McGregor said that hospitals needed to properly inform families of these procedures and that all emphasis should be on "palliative care" for the donor to avoid any unnecessary pain and trauma.

Meeting the Recipient Can Be Therapeutic

Sue McVey Dillon said the organ donation team and Michael's doctors had guided her and her family compassionately "every step of the way."

After Michael's death, Dillon was introduced to the recipient of his liver: 39-year-old Santos Felix, who had been ravaged by years of Hepatitis C acquired from childhood tattoos.

"The relationship was healing for our family," said Dillon, who became friends with Felix, watching his volleyball games and even traveling to Puerto Rico to meet his family.

"This has really helped families who have lost a loved one," said Howard Nathan, president of Philadelphia's Gift of Life program, which organized Michael's transplant.

"It gives families an option when all else is lost," he said. "All of these organs would have been buried if we had not incorporated DCD into the end-of-life care for families. And that would have been a real tragedy."

Ethical Violations

But not all donations have storybook endings. In a starkly different case in San Luis Obispo, Calif., a transplant surgeon may be criminally charged with giving excessive doses of pain medication to hasten the death of 26-year-old donor Ruben Navarro.

Navarro's organs could never be transplanted because he did not die until several hours after being removed from life support. The coroner ruled that he died of natural causes, but ethicists question why the surgeon was involved in the patient's end-of-life care -- a practice banned in hospitals.

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