Actively delaying death to increase organ donation

A wide imbalance exists between the number of solid organs available for transplantation and the number of potential recipients. In an attempt to tackle this imbalance, the National Institute for Health and Clinical Excellence (NICE) has recently issued a guideline that offers best practice advice to increase the number of cadaveric organs available for transplantation.1

Most solid organs donated in the United Kingdom come from patients whose hearts are still beating and in whom no brainstem function can be detected. However, such donation is decreasing worldwide as road safety and medical care improve. Consequently, much of the guideline focuses on ways to increase donation rates from patients judged to have untreatable and rapidly lethal conditions but who do not meet brainstem death criteria. Organs from such patients may be retrieved after certification of death when the heart stops beating. To minimise damage to solid organs, harvesting must occur as soon after cardiac death as possible. This largely limits donation after cardiac death to patients being managed on intensive care units (ICUs), where life sustaining treatment that was started with curative intent is subsequently deemed futile and a decision is made to withdraw it. Treatment withdrawal, and hence death, is usually …