Changing Trends in Organ Donation

March 22, 2007 -- Since the 1970s, it has been standard practice to procure organs from deceased donors after irreversible loss of neurologic activity, but a trend has re-emerged in which organs are also being removed after so-called cardiac death. According to a story in the Washington Post, the trend has been accelerating, with the number of such donations more than doubling in the past three years.

Waiting to remove organs from a donor only after neurologic death occurs became the norm in the 1970s when surgeons began using ventilation-support machinery to keep the donor’s body functioning until transplantation could take place. Prior to this time, donations after circulatory determination of death, or DCDDs, had been commonplace. However, with the growing demand for organs, hospitals are being asked to decide whether to again allow this practice and to develop policies to safeguard the rights of donors and their families. Over 95,000 Americans are currently waiting for a life-saving transplant.

Concerns have been raised by some doctors and ethicists who worry that the definition of death is being blurred, and that ultimately donations could drop. The fear is that donors may opt out rather than face any possibility of their organs being removed prematurely.

The Institute of Medicine has examined the issue in several reports. In 1997 IOM released Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement, which said that DCDDs could be helpful in easing the shortage of needed organs, but procedures first should be put in place to guarantee proper care of the donor patients. The 2006 IOM report Organ Donation: Opportunities for Action also recommended expanding this type of organ procurement but again only after stringent safeguards and policies are in place. Also, an IOM meeting held last December focused on next steps for DCDD programs; participants from New York City, Washington, D.C., and Chicago met to consider the specific next steps needed for their metropolitan areas.

• Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement (1997)
• Organ Donation: Opportunities for Action (2006)
• Meeting Summary -- Moving Forward in Increasing Organ Donation: Opportunities and Barriers to Uncontrolled DCDD in Major Metropolitan Cities (2006)

• Organdonor.gov
• United Network of Organ Sharing
• Joint Commission on Accreditation of Healthcare Organizations Organ Donation and Transplantation Public Policy Page