Criteria for organ donation in the US may change radically, if proposals by the United Network for Organ Sharing, which controls the allocation of organs, are implemented, the Washington Post has reported.
Post reporter Rob Stein said that the possible changes have stirred up a hornet’s nest among bioethicists. However, others say that the article is a beat-up. “This article is a hysterical and inappropriate reaction to a very minor change in some standards. There is zero threat to the public well-being in this document,” says Dr Jeffrey Punch, of the University of Michigan’s Department of Surgery.
The controversy is swirling around UNOS’s guidelines for Donation after Cardiac Death. Most donors are “brain dead”, but increasingly transplant surgeons are removing organs from donors after their heart has ceased to beat. According to UNOS, in 2009, there were 920 DCD donors, an 8.5% increase over 2008. It says that the proposed changes “can increase the number of organs procured from DCD donations and ultimately increase the number of transplants”.
Central to the dispute is how long surgeons should wait before declaring the person dead and removing organs. In recent years, the time has drifted down to two minutes. Now no time is specified. This horrifies some bioethicists.
“This is another step towards this idea of hovering, hovering, hovering to get more organs,” Michael A. Grodin, of Boston University, told the Post. “The bottom line is that they want to do everything they can to increase organ donation.”
UNOS has responded that the waiting time has always been up to the discretion of individual hospitals – there never was a hard and fast two-minute wait time. However, some bioethicists have a very different view. “By this document, every hospital in America can now develop its own definition of ‘dead,’ ” University of Washington bioethicist Gail Van Norman told the Post. “And that is profoundly disturbing... We are, it seems, admitting that we are willing to take the chance of procuring organs from someone who is not dead yet.”
Other changes are also controversial. One is changing the criterion from cardiac death to “circulatory death”. The idea is that an “irreversible cessation of circulatory and respiratory functions” happens if the circulation of the blood is insufficient to sustain life, even if the heart is beating. But this does not convince everyone. “Renaming the process is not successful and is potentially intentionally deceptive,” said Robert M. Veatch, a Georgetown University bioethicist on the UNOS ethics committee.
Another proposal which angers some bioethicists is that the hospital will be able to label the patient as a potential donor before the next-of-kin approves of the transplant. “This change in policy creates the appearance that the patient is always being evaluated as a possible donor, which I think would make the public uneasy, and rightfully so,” said Leslie Whetstine, of Walsh University. However, UNOS describes this as “a service to the grieving family”.
The UNOS board will meet in Atlanta in November to finalise changes to the guidelines. ~ Washington Post, Sept 20