R Herdman, J Potts. National Academy Press, 1997, £15.95, pp 92. ISBN 0-309-06424-4

• Herdman R, Potts J. Non heart beating organ transplantation
• Medical and ethical issues in procurement

The problem of the supply of organs for transplantation is a major concern in many areas of health care practice and more generally in society. For many conditions organ transplantation remains the treatment of choice and in many situations this necessitates a cadaver donor. The possibility of harvesting organs from patients other than those who meet the criteria for brain death has received less publicity, but raises different ethical and legal questions, compared to the more usual situation of brain dead, ventilated patients. Given the general shortage of donor organs, however, this group of patients may represent a useful source.

This report was commissioned in 1997 by the US Department of Health and Human Services and concerns “the management of cadaver donors who died a cardiopulmonary death, called non-heart-beating-donors (NHBDs)”. In these patients death results from an “irreversible cessation of circulatory and respiratory function”, as opposed to cessation of functions of the brain. Questions had been raised about the medical management of such donors and whether the interventions practised could be said to be in the best interests of the patient or were in fact hastening death. The question considered by the report was: “Given a potential donor in an end-of-life situation, what are the alternative medical approaches that can be used to maximise the availability of organs from that donor without violating prevailing ethical norms regarding the rights and welfare of donors? The Institute will consider the alternative approaches, including …