Healthcare News & Insights

Fast-track organ donation: Ethics vs. efficiency

illegal-organ-harvesting

Does a new program to increase the number of organs available for donation cross an ethical line?

A pilot program funded by the Department of Health and Human Services is intended to help doctors at two Pittsburgh health centers more quickly identify potential donors from emergency department patients who can’t be revived.

The two medical centers involved are Allegheny General Hospital and the University of Pittsburgh Medical Center — Presbyterian Hospital.

Under the program, physicians can take organs from patients within minutes of their hearts stopping — even if they have not been declared brain-dead. The practice is known as DCD, or “donation after cardiac death.”

Organs are only taken from patients who have previously indicated a desire to donate, whether by signing up for a state registry or checking a box on their drivers’ licenses. Family consent won’t be sought if no members are present.

The goal is to not only increase the number of organs available, but to get more viable organs by retrieving them faster.

The program’s protocol calls for patients to be pronounced dead and prepared for donation two minutes after resuscitation efforts end — but in practice, the delay is closer to 15 minutes as the organ donation team assembles. (Note: To avoid potential conflicts of interest a patient’s organ donor status isn’t checked until after he or she is pronounced. Different physicians handle resuscitation and donation prep.)

Ethical considerations

It’s well known that there’s a desperate shortage of organs for donation — thousands of Americans die each year waiting for transplants. But some ethicists question if this program is the best way to make more organs available.

Among the concerns raised:

  • Too few safeguards to ensure that organs aren’t retrieved from patients who might be viable after all. (For example, rare cases of revival after pronouncement of death)
  • Emergency Department pronouncements traditionally aren’t considered suitable for organ donation decisions
  • How/when physicians draw the line between treating an individual as a patient being resuscitated and a potential organ donor
  • Whether a patient can give true informed consent when agreeing to organ donation by checking a box on their driver’s license
  • The chaotic atmosphere of emergency departments can cause confusion that leads to patients being pronounced dead too soon, improperly identified as donors, etc.
  • The program may backfire by making people more skeptical and less likely to designate themselves as a donor

Does the program have sufficient safeguards in place? Is this a viable way to increase available donor organs? Share your thoughts in the comments.

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Comments

  1. This would change my current status of a donor. I would encourage this method only when a family member is present and the decision of pronouncement was finalized with that family member.

  2. Sandy Wolkoff says:

    Twenty months ago I received about eight phone calls from an organ donation bank requesting my son’s organs. I heard the tension in the worker’s voice as she said they only just a few hours to remove his heart; a few more hours for his kidneys. Could I give them permission to take his corneas?

    I had just learned of my son’s death, three thousand miles away, and I was in shock. Would I want a parent to be spared the loss of a child, or child to regain the life of an ill parent because of my son’s organs? In a perfect world, yes. But in a world of coroner’s offices and medical examiner’s hours, I could not make a quick decision. Had my son made it to the hospital, and his organ’s donated before I even knew of his death, I would have felt a violation far greater than the pain I was already in.

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