Organ Donation

  • Organ procurement from an individual in whom all brain function has ceased but normal cardiac pump activity continues is “heart-beating organ donation.”
  • Organ procurement after cessation of cardiac pump activity is called “non-heart-beating organ donation (NHBOD).”
  • This is an emerging and important source of transplant donors.
  • Organ procurement is only permitted when the donor is already dead and the act of organ recovery cannot have been the immediate act to cause that death.

  • The main difference between conventional beating heart organ donation and non-beating heart organ donation is the criteria for death.

  • The diagnosis of death is based on brainstem criteria in beating heart donors, whereas it is based on cardiac criteria in the non-beating heart donor.
  • The risk for warm ischemia is higher in the non-beating heart donor organs.
  • Although the non-beating heart organ transplantation has been successful in kidney transplants, where the success rates from the beating and non-beating donors are similar, it is not so for other organ transplants, which have lower success rates when transplanted from non-beating heart donors.

References

  • Liver transplantation from non-heart beating donors (editorial). BMJ 2006;332:376-377 (18 February), doi: 10.1136/bmj.332.7538.376
  • Truog RD. Consent for organ donation — balancing conflicting ethical obligations. New Engl J Med 2008;358(12):1209-1211.
  • Rubenstein A, et al. The definition of death and the ethics of organ procurement from the deceased. The President’s Council on Bioethics. http://www.bioethics.gov/background/rubenstein.html
  • Rady MY, et al. Organ procurement after cardiocirculatory death: a critical analysis. J Intensive Care Med 2008;23:303-12