New Trend in Organ Donation Raises Questions
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.
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....
"A lot of us are not particularly happy about cutting that line particularly close," said Gail A. Van Norman, an anesthesiologist and bioethicist at the University of Washington in Seattle.
Van Norman and others also worry that the practice could pressure family members and doctors to discontinue care, perhaps before it is undeniable that there is no hope. Those fears are particularly acute in pediatric intensive-care units, where the same nurses and doctors frequently care for both potential donors and potential recipients.
While many hospitals are adopting DCD policies, others have delayed because of objections. Some are opting out. One hospital chain went ahead but then instituted a moratorium because of concerns that the local organ bank was becoming too aggressive.
In addition to giving DCD donors morphine, valium and other drugs to make sure they do not suffer as life support is withdrawn, doctors often insert a large tube into an artery and inject drugs such as the blood thinner heparin to help preserve the organs. Some say those measures may hasten death.
"It's worrisome when you stop thinking of the person who is dying as a patient but rather as a set of organs, and start thinking more about what's best for the patient in the next room waiting for the organs," Van Norman said.
In California, police and state medical authorities are investigating whether doctors did anything to speed the death of a donor in San Luis Obispo last year.
David Crippen, a University of Pittsburgh critical-care specialist, asked, "Now that we've established that we're going to take organs from patients who have a prognosis of death but who do not meet the strict definition of death, might we become more interested in taking organs from patients who are not dead at all but who are incapacitated or disabled?"
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