When Are Transplant Donors Declared Dead??

A report in the current New England Journal of Medicine that focuses on heart transplants for babies is bringing the issue of declaring donors dead to the forefront. The standard has been that a donor’s organs are only donated after the donor has been declared brain dead. Once declared brain dead, the donor is put on a ventilator to keep oxygen flowing to the organs until they can removed.

The procedure being reported is called donation after cardiac death. In the cases of the infants in the report they were on life support and had little brain function. However, they did not meet the criteria of brain death. Within minutes of being off the ventilator their hearts stopped. They were successfully transplanted to other infants.

“It seemed like there was an unmet need in two situations,” said Dr. Mark Boucek, who led the study at Children’s Hospital in Denver. “Recipients were dying while awaiting donor organs. And we had children dying whose family wanted to donate, and we weren’t able to do it.”

Donation after cardiac death raises both legal and ethical issues because it involves laws concerning when organs can be removed and because it involves children.

The procedure is being encouraged by the federal government, organ banks and others as a way to make more organs available and give more families the option to donate. However it has critics who maintain, among other things, that the definition of death is flawed, and that more emphasis should be on informed consent and the chances of survival in cases of severe brain damage.