Abstract
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.
Résumé
Objectif
L’écart croissant entre le nombre d’individus qui attendent une greffe d’organe et le nombre d’organes disponibles pour la transplantation soutient les tentatives d’augmenter le nombre d’organes disponibles. Dans certains pays, le prélèvement d’organes se fait chez des donneurs à cœur non battant (DCNB). L’objectif de la présente revue est de discuter des questions éthiques entourant cette pratique.
Source
La revue descriptive provient de références choisies dans Medline et d’autres articles publiés.
Constatations principales
Des protocoles de dons de DCNB ont été établis dans de nombreux pays, y compris les États-Unis. Malgré de nombreuses publications, et un intense débat dans la littérature scientifique, d’importantes questions d’éthique demeurent non résolues sur le retrait d’organes chez des donneurs morts à la suite de l’arrêt de l’activité cardiaque. Les préoccupations éthiques concernent principalement la détermination de la mort, la tension entre les contraintes de temps entourant le prélèvement d’organes viables pour la greffe et les techniques d’amélioration de la viabilité des organes. Malgré une mobilisation aux États-Unis, moins de la moitié des organisations de prélèvement d’organes ont établi des protocoles de DCNB.
Conclusion
Les centres canadiens peuvent apprendre à partir des difficultés rencontrées par d’autres centres qui ont mis au point des protocoles DCNB. Un moratoire sur les protocoles DCNB canadiens devrait être envisagé jusqu’à ce que soit établi un consensus national exprimant les valeurs canadiennes.
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Doig, C.J., Rocker, G. Retrieving organs from non-heart-beating organ donors: a review of medical and ethical issues. Can J Anesth 50, 1069–1076 (2003). https://doi.org/10.1007/BF03018376
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DOI: https://doi.org/10.1007/BF03018376