Organ donations raising concerns

Surgeons must wait five minutes after the heart stops beating.
WASHINGTON POST
The number of kidneys, livers and other body parts surgeons are harvesting through a controversial approach to organ donation has started to rise rapidly, a trend that is saving the lives of more waiting patients but, some say, risks sacrificing the interests of the donors.
Under the procedure, surgeons are removing organs within minutes after the heart stops beating and doctors declare a patient dead. Since the 1970s, most organs have been removed only after doctors declared a patient brain dead.
Federal health officials, transplant surgeons and organ banks are promoting the alternative as a way to meet the increasing demand for organs and to give more dying patients and their families the solace of helping others.
Some doctors and bioethicists, however, say the practice raises the disturbing specter of transplant surgeons preying on dying patients for their organs, possibly pressuring doctors and families to discontinue treatment, adversely affecting donors' care in their final days and even hastening their deaths.
On the rise
Nevertheless, the number of these donations is on the rise. It more than doubled from 268 in 2003 to at least 605 in 2006, enabling surgeons to transplant more than 1,200 additional kidneys, livers, lungs, hearts and other organs.
"It's starting to go up exponentially," said James Burdick, who leads organ-donor efforts at the federal Department of Health and Human Services.
The trend is expected to accelerate this year. For the first time, the United Network for Organ Sharing, which oversees organ procurement, and the Joint Commission on Accreditation of Healthcare Organizations, which accredits hospitals, are requiring all hospitals to decide whether to allow the practice. In response, medical centers are scrambling to develop policies, sometimes sparking intense debate, especially at children's hospitals.
"It's an example of pushing the envelope to get more organs," said Stuart J. Youngner, a bioethicist at Case Western Reserve University. "Whenever we do that, we tend to step on various traditional social taboos."
Procedure
The approach, known as donation after cardiac death (DCD), usually involves patients who have suffered brain damage, such as from a car accident or a stroke. After family members have made the difficult decision to discontinue a ventilator or other life-sustaining treatment, organ-bank representatives talk to them about donation.
Sometimes, the donor is suffering from an incurable disorder such as Lou Gehrig's disease and wants to donate his or her organs after deciding to forgo further care.
Once the decision has been made, a transplant team waits nearby so surgeons can begin removing organs soon after the heart stops. Because the heart can sometimes restart spontaneously, doctors wait a few minutes after pronouncing death before allowing the surgeons to begin. If the heart does not stop quickly, usually within an hour, the procedure is aborted and the patient is taken back to his or her room until death comes.
The practice was the norm before brain death became the standard for pronouncing death in the early 1970s and surgeons began keeping the donor's body functioning with life-support machinery until transplantation could begin. When surgeons resurrected what was then called nonbeating-heart donation in the 1990s, critics called it ghoulish and said it raised a host of ethical questions. Some called it tantamount to murder.
The National Academy of Sciences' Institute of Medicine examined the practice, however, and concluded that it is ethical as long as strict guidelines are followed, including making sure the decision to withdraw care is independent of the decision to donate organs and that surgeons wait at least five minutes after the heart stops.
"People are dying on the waiting list," said Francis L. Delmonico, a transplant surgeon at Harvard Medical School, speaking on behalf of the United Network for Organ Sharing. More than 95,000 Americans are waiting for organs. "This is vital as an untapped source of organ donors."