Archives For non heart beating donors

Beating Heart Donors

SurgerySurgeons retrieving organs for transplant just after a donor’s heart stops beating would no longer have to wait at least two minutes to be sure the heart doesn’t spontaneously start beating again if a new policy is passed by the National Procurement Organization.

Donation by Cardia Death is the same term a as non beating heart donor. However, if the rule revision is passed it can now be called:  “donation after circulatory death.” That terminology, advocates say, is more accurate, given that the heart might not necessarily be “dead” before “death” can be declared.

Regardless of what they call it, non heart beat donor, donation by cardiac death or donation after circulatory death it still involves surgeons taking organs within minutes of respirators and other forms of life support being cut off from hospitalized patients who still have at least some brain activity.”

Most hearts, lungs, kidneys, livers and other organs obtained for transplants in the United States have come from patients who have been pronounced “brain dead” in a hospital.

The dead donor rule

The dead donor rule basically says that before an organ can be harvest the patient must be declared dead.

The “dead-donor rule” refers to two accepted ‘ethical norms’ that govern the practice of organ harvesting before transplantation:

1) vital organs should be taken only from dead patients,

2) living patients should not be killed for or by organ procurement.

If you have a loved one in a critical condition or a coma, you will be asked about donating after cardiac death or circulatory death. We were with my son by an Organ Procurement agent hovering around us. They did this when we disputed “brain death” as being really dead. (details in the book)

“There’s a fine line between methods that are pioneering and methods that are predatory,” said Leslie M. Whetstine, a bioethicist at Walsh University in Ohio. “This seems to me to be in the latter category. It’s ghoulish.”There’s no consensus regarding how long CPR must be performed before death is determined as irreversible. In other words, when in the resuscitation process does the patient transition from being treated as a patient to a donor?” Whetstine asked. “Are such patients really dead after resuscitation efforts end and after a time interval of two minutes of cessation of circulation elapses?”

This is a really good article by Discover Magazine on the The Beating Heart Donors |

Here is a comment on by an operating room nurse:

I’m an Operating Room Nurse @ a trauma hospital that performs harvest on brain dead patients. We recently started to do harvest on patients that are not declared brain dead, but their prognosis is considered grave and not recoverable. I myself refuse to be involved in this type of harvest. The patient is brought into the Operating Room then prepped and draped ready to cut. The patient is then disconnected from the ventilator. The clock starts and the patient has an hour to “die” on the table as we all stand around and wait for the absence of cardiac activity. My fellow co-workers who have been involved in this type of harvest tell some disturbing stories. Patients who show signs of panic once the assisted ventilation is removed: Squirming, arm and leg movements, facial distortion. Behavior one would expect to see by someone who is being suffocated. We’ve been told that if a patient’s family member wants to be there at the time of death, we are suppose to accommodate them. I can’t imagine wanting to see someone I love die in such a terrible manner. If the patient still has a heart beat after an hour, we are to remove the patient from the Operating Room and return them back to their hospital room. This is without any ventilation or support of any kind. Just waiting for the patient to expire.

Personally this is highly unusual to let a family anywhere near the operating room but this is what the nurse said.

Flickr Photo Credit

***I haven’t written in over a week, Real Estate in Ann Arbor is crazy busy right now.****

Non-Heart Beating Donors

I have written quite extensively on organ donation. Since this blog is a prelude to the book coming out in October I want to write about non heart beating donors. (NHBD)

In April of 1997, Mike Wallace of 60 Minutes did a piece on “Are surgeons taking organs from patients who are not quite dead?” At the end of his piece, Mike Wallace predicted that taking organs from the “not quite dead” or non heart beating donors would go away.

He was wrong.

It has not gone away.

Jamie Caulk in hospitalWhen we were at Vanderbilt, Mike and I were in with Jamie praying over him. I felt someone in the room and opened my eyes and looked at the foot of bed. There she was…an Organ Requester.

What are you doing in here, I asked.

“Well I heard you wanted to donate your son’s organs by having his heart stop beating first.”

No, you heard wrong, I said. I don’t appreciate appreciate you coming in my son’s room and discussing this in front of him, didn’t you see we were praying?” “Now please leave you are not getting one organ from my son.”

Current regulations require hospitals across the United States to notify the Organ Procurement Agencies when a patient is in a coma. If it is a federally funded hospital they can lose their funding if they do not notify them.

The Uniform Anatomical Gift Act (UAGA) assigns explicit priority to the donor’s expressed intent so that consent for organ donation becomes irrevocable and does not require the consent or agreement of any person after the donor’s death.

The donor’s authorization to donate, recorded on an organ donor card, the individual’s driver’s license, or a donor registry, becomes a legally binding advance directive. The UAGA amendment enables OPOs to procure organs without family consent and in certain instances after family refusal to donate.

Organ Procurement Organizations

The OPO at Vanderbilt asked us if they could go ahead and start running tests on Jamie to see if he was suitable for donation.

Andrew-David Caulk My son, Andrew spoke up before any of us could, “No, you are not doing that, you are only hastening my brother’s death, we want him to wake up, you are NOT doing any tests.”

Organ Procurement Organizations have set goals to get your organs, with an average of 75% being the norm.

The Revised UAGA changes the default “non-donation” with “intent to donate” by presuming that a person automatically wants to donate. In the current default option “intent to donate” everything is done medically to ensure the stability of the patient until the OPO’s can determine the medical suitability of the person as a perspective donor.

However, under mandated consent the OPO’s would not have to even ask or request permission because the removal of organs would be compulsory.

Mandatory consent overrides the health care directive that many wise people have written for their end of life care.

One of the critical issue’s with the non heart beating donor is by waiting 2-5 minutes (depending on which hospital you are in and what their protocol is) overrides the “dead donor rule”. I have posted here that by pronouncing death it rules out that the harvesting of the organs causes the death of the person.

NHBD is a donor whose death is defined by “irreversible cessation of circulatory and respiratory functions” as opposed to “irreversible cessation of all functions of the entire brain, including the brainstem” (Uniform Determination of Death Act, 12 Uniform Laws Annotated 320.

If you believe as I and many other’s do that a brain dead person, is not truly dead, you will still be approached to consider your loved one being a non-heart beating donor.

What to do when you are approached about donation by cardiac death

Prior to donation, the patient will be given heparin and phentolamine (Regitine), they are taken off life support, the heart will stop for 2-5 minutes, or they will check your pulse for just a very few seconds and pronounce you dead.  You will be resuscitated, put back on life support and the harvesting will begin.

My recommendation is:

1) Do not allow heparin or phentolamine drugs. Heparin and phentolamine would NOT be drugs given to a patient care unless they were considering organ donation. In certain patients under certain circumstances, these drugs may actively hasten death. They are only used to enhance organ quality.

2) Understand that non-beating heart donation is a way to increase organ donation’s.  By removing you from life support before you have died  and for some reason can not be called brain dead.

3) Do not let them start to take blood and tissue samples.

4) Do not let them cannulate. This is a when they insert a tube into the artery in the femoral artery and femoral vein prior to withdrawal of life support. Cannulation is done so that organs can cooled and preserved to improve transplant outcomes.

5) Non-heart beating donation is a fall back to get organs when they can’t proclaim brain death.

Journal of Hospital Medicine written by Mohamed Y. Rady, MD, PhD, and Joseph L Verheijde, PhD, MBA and Joan McGregor, PhD. 2007; 2(5):324-334. 

Read more at Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement