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Ventilating the debate: elective ventilation revisited
  1. Dominic Wilkinson
  1. Correspondence to Dr Dominic Wilkinson, Department of Neonatal Medicine, University of Adelaide, 72 King William Rd, North Adelaide, South Australia 5006, Australia; dominic.wilkinson{at}adelaide.edu.au

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This issue of the Journal of Medical Ethics features a special symposium on ‘elective ventilation’ (EV). EV (also known as ‘non-therapeutic ventilation’ (box 1)) was originally described in the 1990s by doctors working in Exeter in the UK.1 At that time there was concern about the large shortfall in organs for transplantation. Patients could become organ donors if they were diagnosed as being brain dead, but this only ever occurred in patients on breathing machines in intensive care who developed signs of brainstem failure. Doctors wondered if there were patients dying outside intensive care who, if they were ventilated, could become brain dead and hence eligible to donate their organs. They embarked on a process of identifying patients who were dying who would not normally be taken to intensive care because their prognosis was judged to be too poor, and then ‘electing’ to insert breathing tubes when they stopped breathing.1 With the consent of family members the patients were supported in intensive care until they were diagnosed as having signs of brain death, or until the family and doctors together judged that this was unlikely to occur.1 The Exeter team saw a 50% increase in their numbers of organs for transplantation.

Box 1
  • Definition of elective ventilation

  • Elective ventilation (EV) is the provision to a patient of intensive medical treatment(s) with the sole purpose of facilitating organ donation, in the absence of an expected medical benefit.

EV was a controversial practice at the time. There were a number of papers written from points of view defending2 ,3 and criticising it.4 A Department of Health guideline in 1994 concluded that EV was not in the best interests of patients and was therefore unlawful5; subsequently, the practice effectively ceased.2 However, debate about EV has not …

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