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Retrieving organs from non-heart-beating organ donors: a review of medical and ethical issues

[Prélèvement d’organes chez des donneurs à cur non battant : une revue éthique et médicale]

Christopher James Doig, MD MSc^* and Graeme Rocker, DM MHSc

^* From the Department of Critical Care Medicine and The Office of Medical Bioethics, Faculty of Medicine, University of Calgary, Calgary, Alberta;
and the Department of Medicine, Dalhousie University, and The Intensive Care Program, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.

Address correspondence to: Dr. Christopher Doig, Department of Critical Care Medicine, Room EG23G, Foothills Medical Centre, 1403, 29th Street N.W., Calgary Alberta T2N 2T9, Canada. E-mail: cdoig{at}ucalgary.ca

Purpose: The increasing gap between numbers of individuals awaiting organ replacement surgery and the supply of organs available for transplant underpins attempts to increase the number of organs available. One practice, used in other countries, is the recovery of organs from non-heart-beating organ donors (NHBD). The purpose of this review is to discuss ethical issues surrounding the use of organs from these donors.

Source: Narrative review from selected Medline references, and other published reports.

Principal findings: NHBD protocols have been established in many countries including the United States. Despite numerous publications, and extensive debate in the literature, significant ethical issues remain unresolved in the retrieval of organs from donors that have died from cessation of cardiac activity. The ethical concerns primarily arise in the determination of death, the tension between the time constraints on recovering organs viable for transplantation, and procedures to enhance organ viability. Despite a concerted effort in the United States, less than half of the organ procurement organizations have NHBD protocols.

Conclusion: Canadian centres can learn from the difficulties encountered in other centres that have developed NHBD protocols. A moratorium on Canadian NHBD protocols should be considered until a National consensus reflecting Canadian values has been undertaken.

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