By Nancy Valko, RN, ALNC
Most people who sign organ donor cards assume that they will be carefully diagnosed as “brain dead” before their organs are donated. That was generally true years ago, but a new non-brain death organ donation procedure was developed in the 1990s even though the language on organ donor cards did not change.
The current non-brain death organ donation policy started with ethics journal articles in the 1990s. At that time, it was called “non-heart beating donation” and promoted as a way to increase the supply of organs for transplant beyond the usual “brain death” organ donations. This was made possible by linking organ donation to withdrawal of treatment decisions from people considered hopelessly ill or dying but who did not meet the criteria for “brain death.”
This change in policy came in the wake of court decisions upholding the right to refuse treatment for incapacitated patients like Nancy Cruzan, a brain-injured woman said to be in a so-called “vegetative state.”
Since Dr. George Isajiw and I presented the following paper (“Non-heart beating organ donation” and the “vegetative state”) in 2004, the term “non-heart beating organ donation” has been changed to “donation after cardiac death” (DCD) and now around 5% of organ donations are from nonbrain death organ donors.[i] The numbers are expected to increase with organ donation policies such as the following: In June 1996, the American Medical Association issued its opinion that non-brain death organ donation was ethical.[ii] Eventually, the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) required all hospitals to develop policies for DCD, effective January 2007, while the United Network for Organ Sharing (UNOS) proposed new bylaw amendments requiring all transplant centers and Organ Procurement Organizations (OPOs) to develop DCD policies by January 1, 2007.[iii]
Moreover, hospitals currently are being asked to report all deaths, imminent deaths and potential organ donor situations to the local organ procurement organization. Years ago, when only brain death criteria could be used, doctors themselves talked to families about organ donation. Now, many hospitals have policies that only trained organ donation representatives talk to families about donation. Such policies are said to increase the number of families consenting to organ donation.
In Part Two, I will discuss other strategies to increase the number of organ donations.
[i] “The Challenge of Organ Donation After Cardiac Death,” Matt Wood, Science Life, 02/20/2014; http://sciencelife.uchospitals.edu/2014/02/20/the-challenge-of-organ-donation-after-cardiac-death
[ii] “Opinion 2.157 – Organ Donation After Cardiac Death,” AMA Code of Medical Ethics, issued 06/1996 and updated 06/2005; http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2157.page
[iii] “Donation After Cardiac Death: Analysis and Recommendations from the New York State Task Force on Life &the Law,03/17/2007;http://www.health.ny.gov/regulations/task_force/donation_after_cardiac_death/docs/donation_after_cardiac_death.pdf
Nancy Valko, RN, ALNC, has been a registered nurse for 45 years and is a spokesperson for the National Association of Prolife Nurses (www.nursesforlife.org). A long-time speaker and writer on medical ethics and other health issues, she has a website at: http://www.wf-f.org/bd-nvalko.html.She is also now a legal nurse consultant (www.valkogroupalnc.com ).
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This article is printed with permission.