Currently, the U.S. promotes organ recovery from three sources: neurologic deaths, controlled circulatory deaths and live donors for kidneys and partial livers.
The three viewpoint authors — Stephen P. Wall, MD, of Bellevue Hospital Center in New York City and the NYU School of Medicine; Carolyn Plunkett of the NYU School of Medicine Division of Medical Ethics; and Arthur Caplan, PhD, of the City University of New York Graduate Center Philosophy Program — suggest the U.S. follow in Europe’s footsteps and use transplantable organs through uncontrolled donation after circulatory determination of death, or UDCDD.
UDCDD considers decedents candidates for donation even when death is unexpected, regardless of location, as long as preservation begins after all life-sustaining efforts have been exhausted.
According to the authors, the public may support UDCDD but, unlike European programs that initiate organ preservation without requiring explicit consent, the U.S. public will not allow organ preservation without consent.
The authors argue the problem with prior consent is it limits the donor pool and there is reason to doubt whether family or other authorized persons have the emotional and cognitive wherewithal to authorize organ donation immediately after learning about or witnessing a loved one’s unexpected death.
“Authorized persons are likely overwhelmed and unable to think clearly,” wrote the authors. “Given the difference in circumstances and timing, eliciting authorization to donate following unexpected death should, for ethical reasons, be treated uniquely.”
The authors suggest a two-step authorization process following unexpected death to better support grieving family members while increasing opportunities for donation through UDCDD:
Step one — Seek permission to maintain the body for possible organ donation after unexpected death. This step requires only that families and other authorized persons are able to indicate a choice to begin organ preservation, not a full authorization for donation.
Step two — Seek authorization to donate. Family members and loved ones initially need time to process the fact that death has occurred. Later they need the opportunity to weigh the pros and cons of donation against the decedent’s and family’s values.
“With the appropriate ethical framework to obtain permission for preservation immediately following unexpected circulatory determination of death, with the actual decision to authorize donation made hours thereafter, the pool of potential donors could be greatly expanded while respecting autonomy, choice, and vulnerability,” the authors concluded.
More articles on organ transplant programs:
UPMC’s transplant program put on probation
UPMC extends transplant services beyond Pittsburgh
Cedars-Sinai Medical Center opens new transplant center
