Non Heart Beating Organ Transplantation

In 1997, the Institute of Medicine published a report entitled Non-Heart- Beating Organ Transplantation: Medical and Ethical Issues in Procurement. The findings and recommendations of that study defined the ethical and scientific basis for non-heart-beating organ donation and transplantation, and provided specific recommendations for practices that affirm patient welfare, promote patient and family choice, and avoid conflicts of interest. Following the 1997 study, the Department of Health and Human Services requested a follow up study to promote such efforts. The central activity for this study was a workshop held in Washington, D.C., on May 24-25, 1999. The workshop provided the opportunity for extensive dialogue on non-heart-beating organ donation among hospitals and organ procurement organizations (OPOs) that are actively involved in non-heartbeating organ and tissue donation and those with concerns about whether and how to proceed. The findings and recommendations of this report are based in large measure on the discussions and insights from that workshop. Non-Heart-Beating Organ Transplantation includes seven recommendations for developing and implementing non-heart-beating-donor protocols. These recommendations were based on the findings and recommendations from the 1997 IOM report and consensus achieved among participants at the national workshop. The committee developed these recommendations as steps towards an approach to non-heart-beating-donor organ donation and procurement consistent with underlying scientific and ethical guidelines, patient and family options and choices, and public trust in organ donation.

In 1997, the Institute of Medicine published a report entitled Non-Heart- Beating Organ Transplantation: Medical and Ethical Issues in Procurement. The findings and recommendations of that study defined the ethical and scientific basis for non-heart-beating organ donation and transplantation, and provided specific recommendations for practices that affirm patient welfare, promote patient and family choice, and avoid conflicts of interest. Following the 1997 study, the Department of Health and Human Services requested a follow up study to promote such efforts. The central activity for this study was a workshop held in Washington, D.C., on May 24-25, 1999. The workshop provided the opportunity for extensive dialogue on non-heart-beating organ donation among hospitals and organ procurement organizations (OPOs) that are actively involved in non-heartbeating organ and tissue donation and those with concerns about whether and how to proceed. The findings and recommendations of this report are based in large measure on the discussions and insights from that workshop. Non-Heart-Beating Organ Transplantation includes seven recommendations for developing and implementing non-heart-beating-donor protocols. These recommendations were based on the findings and recommendations from the 1997 IOM report and consensus achieved among participants at the national workshop. The committee developed these recommendations as steps towards an approach to non-heart-beating-donor organ donation and procurement consistent with underlying scientific and ethical guidelines, patient and family options and choices, and public trust in organ donation.

Non-heart-beating donors (individuals whose deaths are determined by cessation of heart and respiratory function rather than loss of whole brain function) could potentially be of major importance in reducing the gap between the demand for and available supply of organs for transplantation. Prompted by questions concerning the medical management of such donorsâ€"specifically, whether interventions undertaken to enhance the supply and quality of potentially transplantable organs (i.e. the use of anticoagulants and vasodilators) were in the best interests of the donor patientâ€"the U.S. Department of Health and Human Services asked the Institute of Medicine to examine from scientific and ethical points of view "alternative medical approaches that can be used to maximize the availability of organs from [a] donor [in an end-of-life situation] without violating prevailing ethical norms...." This book examines transplantation supply and demand, historical and modern conceptions of non-heart-beating donors, and organ procurement organizations and transplant program policies, and contains recommendations concerning the principles and ethical issues surrounding the topic.

Non-heart-beating donors (individuals whose deaths are determined by cessation of heart and respiratory function rather than loss of whole brain function) could potentially be of major importance in reducing the gap between the demand for and available supply of organs for transplantation. Prompted by questions concerning the medical management of such donors--specifically, whether interventions undertaken to enhance the supply and quality of potentially transplantable organs (i.e. the use of anticoagulants and vasodilators) were in the best interests of the donor patient--the U.S. Department of Health and Human Services asked the Institute of Medicine to examine from scientific and ethical points of view "alternative medical approaches that can be used to maximize the availability of organs from [a] donor [in an end-of-life situation] without violating prevailing ethical norms...." This book examines transplantation supply and demand, historical and modern conceptions of non-heart-beating donors, and organ procurement organizations and transplant program policies, and contains recommendations concerning the principles and ethical issues surrounding the topic.

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1997-01 edition. Excerpt: ...freedom within some areas while setting minimum standards in others. In general, the NHBD protocols received and reviewed by the IOM have been written or approved within the last 4 years. The oldest was revised and approved in 1993, and the most recent was approved in July 1997. With respect to OPOs that have approved protocols in place, it is important to bear in mind that organs are procured from very few NHBDs (only one or two) by most OPOs each year. The fact that there are 25 OPOs with approved NHBD protocols and that UNOS reports 65 NHBDs in 1996 provides confirmation of the low rate of procurement of organs from NHBDs by most OPOs. Currently, OPOs located at hospitals tend to procure more organs from NHBDs. Review of the NHBD protocols submitted to the IOM reveals a consensus among OPOs in two areas: (1) discussion of organ donation with families and informed consent should take place only after an independent decision to withdraw life support has been made; and (2) the physician who declares death after withdrawal of support shall not be affiliated in any way with the OPO, procurement team, or transplant team. Outside of these two areas, OPO protocols for NHBDs differ greatly. Some variations are merely procedural whereas others imply ethical differences. The criteria for determining death; medical interventions, including the use of heparin and phentolamine, which are directed toward preparation for transplantation rather than donor patient care; intervention by the OPO to assess and prepare the donor before consent for donation and declaration of death; and the timing, approach, and detail of obtaining family consent--all are problematic issues discussed next in this report. A consensus on these issues, expressed in more...

With the success of organ transplantation and the declining number of heart beating cadaver donors, the number of patients awaiting a transplant continues to rise. This means that alternative sources of donors have been sought, including donors after cardiac death. Such donors sustain rapid damage to their organs due to ischaemia, and as a consequence some organs do not work initially and some none at all. The proportion of such transplants has increased dramatically in recent years- 25% of kidney transplants in the UK were from such donors in 2006 highlighting how much progress has been made. Written by international experts, this book lays out the moral, legal and ethical restraints to using such donors for organ transplant together with the techniques that have been adopted to improve their outcome. The different approaches and results of renal transplant according to country are covered together with the procedures and outcomes adopted to use other organs, notably the liver and lungs.

This book describes the different uses of donors of organs after cardiac death around the world, based on different laws and logistical issues around the world. Developments have allowed these programmes to flourish such that in 2006 25% of UK kidney transplants were from such donors.