ORIGINAL ARTICLE

Non-heart beating organ donation: old procurement strategy—new ethical problems

M D D Bell

Correspondence to:
Correspondence to:
Dr M D D Bell, Consultant in Intensive Care, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK;
dom{at}wybells.freeserve.co.uk

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor (NHBOD) is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death (BSD) does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible.

Keywords: non-heart beating organ donation; end of life decisions; definition of death; conflict of interest; double effect; informed consent

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This article has been cited by other articles:

• Bell, M. D. D. (2008). Non-heart beating organ donation: in urgent need of intensive care. Br J Anaesth 100: 738-741 [Full Text]  
• DuBois, J. M., Delmonico, F. L., D'Alessandro, A. M. (2007). When Organ Donors Are Still Patients: Is Premortem Use of Heparin Ethically Acceptable?. Am J Crit Care 16: 396-400 [Full Text]  
• Van De Wauwer, C., Neyrinck, A. P., Geudens, N., Rega, F. R., Verleden, G. M., Verbeken, E., Lerut, T. E., Van Raemdonck, D. E.M. (2007). Retrograde flush following topical cooling is superior to preserve the non-heart-beating donor lung. Eur. J. Cardiothorac. Surg. 31: 1125-1133 [Abstract] [Full Text]  
• Bell, M D D (2006). Emergency medicine, organ donation and the Human Tissue Act.. Emerg. Med. J. 23: 824-827 [Abstract] [Full Text]  
• Bell, M D D (2006). The UK Human Tissue Act and consent: surrendering a fundamental principle to transplantation needs?. J. Med. Ethics 32: 283-286 [Full Text]  
• Bell, M. D. D. (2005). Non-heartbeating organ donation: clinical process and fundamental issues. Br J Anaesth 94: 474-478 [Abstract] [Full Text]  
• Savulescu, J (2003). Death, us and our bodies: personal reflections. J. Med. Ethics 29: 127-130 [Full Text]  

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Organs for donation, gift or right?

Helen E Pilling

JME Online, 25 Jul 2003 [Full text]