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The decision to donate organs after death requires tremendous courage and conviction on the part of the donor. Organ donation per se is not a new phenomenon. However the recent trend of harvesting organs barely minutes after the donor's heart has stopped beating is ethically debatable. The practice of "donation after cardiac death" or DCD is rising in popularity, reports the Washington Post.
Organ donation traditionally follows declaration of brain death by doctors. The newspaper report cites a spurt in practice of harvesting organs following cardiac death, which is not a commonly followed practice. But the report adds that it is not new either.
Donating organs barely minutes after a patient's heart has stopped beating has risen steadily from 268 in 2003 to at least 605 in 2006. The main reason behind the increasing acceptability of "donation after cardiac death" is the fact that vital organs like heart, lungs and liver need to be harvested as early as possible. Early harvesting ensures that they can be used in needy patients and also increases the chance of saving lives.
James Burdick, who leads organ-donor efforts at the federal Department of Health and Human Services, said that the trend of DCD was rising exponentially. Ethical aspects behind organ donation after cardiac death are also an issue. The argument is that harvesting organs immediately after heart failure severely limits the chances of recovery of the donor, however limited these might be.
Regulation of organ donation in the United States falls under the purview of the states via the federal National Organ Transplant Act of 1968. Each state has separate provisions in its Uniform Anatomical Gift Act, which seek to standardize the practice of organ donation within their own boundaries.
Organs that can be donated after death include heart, intestines, kidneys, lungs, liver, pancreas, while living donors can donate lung, partial liver and the kidney. A survey conducted by the National Public Opinion Survey on Organ Donation in 2005 found 95 percent of respondents willing to donate organs. This number was up from the 93 percent who assented in a 1993 poll by The Gallup Organization for the Partnership for Organ Donation.
Survey results say that some 52.3 percent of Americans have already granted permission for donation of organs or tissues. Their consent is duly recorded on a driver’s license or an organ donor card. In the 1993 poll only about 28 percent has granted permission for organ donation on a driver’s license or an organ donor card.
Organ donation is assuming importance because of the acute shortage in donated organs. In the United States there are at least 95,424 people waiting for organs, according to the Organ Procurement and Transplantation Network (OPTN). Approximately 300 new transplant candidates are added to the waiting list each month.
In such a scenario harvesting organs at cardiac death is assuming increasing importance. The United Network for Organ Sharing, which oversees organ procurement, and the Joint Commission on Accreditation of Healthcare Organizations, which accredits hospitals have now decided to ask hospitals to take specific stand on the issue.
"It's an example of pushing the envelope to get more organs," Stuart J. Youngner, a bioethicist at Case Western Reserve University was quoted as saying by The Post. "Whenever we do that, we tend to step on various traditional social taboos."
Donation at Cardiac death usually involves patients who have suffered extensive brain damage as in case of accidents or strokes. Jerry A. Menikoff, an associate professor of law, ethics and medicine at the University of Kansas is against this practice saying that technically the person is not dead.
"They are going to be dead, but we should be honest and say that we're starting to remove the organs a few minutes before they meet the legal definition of death," he added.
The debate over whether donation after cardiac death is acceptable will continue n the coming years. But a concern among advocates is that this procedure may discourage potential organ donors from signing up.
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