Posted on 08/16/2002 7:27:42 PM PDT by Mulder
Doctors at several Denver-area hospitals no longer will have to wait for a patient to become "brain dead" before harvesting organs, but can take organs from prospective donors as soon as their hearts stop beating. Nationally, organ donation experts predict, the change could increase the number of eligible donors by about 14 percent.
St. Anthony Central changed its policy a year ago. The University of Colorado Hospital, Swedish Medical Center, Children's Hospital, Presbyterian/St. Luke's, Porter and the Medical Center of Aurora are preparing to follow suit.
Under the hospitals' former policies, only people who had been declared legally brain dead could be organ donors. Those people's organs were harvested while the heart was still beating with the help of a machine. Doctors have traditionally believed the beating heart was necessary to ensure the organs were viable.
Under the new policy, patients who still have brain activity could be donors as long as their hearts have stopped. The change in policy reflects in part new studies that show organs from people whose hearts have stopped are still sound.
"It respects the patients' wishes . . . and it helps people dying on the waiting lists," said Dr. Susan Mandell, an anesthesiologist at University Hospital who chairs the committee writing the hospital's new policy.
The change in policy will particularly affect people with critical brain injuries who can lie hooked to a ventilator in a vegetative state, with little brain activity, for years. Metro-area hospitals said they get two or three requests a month from families who want to let loved ones in that condition be organ donors, but their policies have forced them to say no.
If the new policy were embraced aggressively nationwide, it could allow for 2,000 more people to receive the organs they need, according to the United Network for Organ Sharing, the federal agency in charge of organ procurement nationwide. The agency estimates organs could be harvested from 1,000 more people nationwide each year. Just over 6,000 people a year now give organs.
On average, donors give two organs apiece.
"There is a critical need of organ donors," said Sue Dunn, vice president of Donor Alliance, which coordinates organ transplants and recoveries for Colorado and most of Wyoming. "We need to look at every available avenue to have more donors."
But organ donation from people who still have brain activity is hard to accept for many doctors, who have been trained since the 1970s that "brain death" is the only way to ensure the organs are viable, according to Dr. Mark Geraci, assistant chief of medicine at University Hospital.
Hospitals also fear that families will think it cold and tasteless for doctors and transplant experts to approach them about organ donation before the person is even dead. In a successful case, the family would OK the organ donation, the patient would be unplugged from a ventilator in the operating room, the heart would stop beating, and the organs would be harvested.
In the case of brain death, the patient is understood to be dead before the subject of donation is even broached. The family then gives the OK and the organs are harvested while the patient's heart is beating.
Families' permission is not sought if the patient has already signed up on the donor registry at the Colorado Department of Motor Vehicles.
At least 30 states allow organ donation from patients who aren't brain dead - some have had the policies for 10 years - but most have had only two to three patients a year donate organs this way.
St. Anthony Central began the policy a year ago but has had only one woman donor who gave a kidney and a pancreas.
Sue Pease, an intensive-care nurse at St. Anthony, said the woman was the only candidate for organ recovery after a cardiac death the hospital has seen.
But Paul Schwab, executive director of the Association of Organ Procurement Organizations, an umbrella group representing organ centers nationwide, said use and expansion of the cardiac-death policy have been slow nationwide.
He attributed that to the doctors' comfort level with recognizing potential donors who are on life support. In addition, he said, there have been problems with public perception.
In the mid-1990s, for example, reports that hospitals were injecting vegetative patients with drugs that would preserve organs but hasten death surfaced in media outlets nationwide.
In response, the Department of Health and Human Services asked the Institutes of Medicine to look into the issue and produce guidelines. Those guidelines came out in mid-1999.
Colorado hospitals are adopting rules from this report. A patient's heart has to stop within an hour of being unplugged from a ventilator. Recovery experts will wait five minutes before harvesting the organs, in case the person's heart begins pumping again on its own, Dunn said.
If a patient dies in the emergency room or during surgery, he or she wouldn't be an organ donor because doctors want to be in a calm environment when they decide a person can't live without a ventilator.
Also slowing acceptance of the new policy had been fear that organs from a donor whose heart had stopped beating weren't as good as those from a brain-dead donor.
But a Swiss study released two weeks ago showed that organs taken from two different kinds of patients - those who died a brain death and those who died a cardiac death - had virtually the same success rate with the people who received those organs. Doctors followed nearly 250 transplant patients for 15 years and found nearly identical survival rates.
University Hospital officials said they expect to begin screening for donors in eight weeks and plan to get as many donors as possible. University has already begun training staff on how to recognize potential donors before they die.
To avoid looking predatory, the hospital will have someone from the Donor Alliance approach families.
"We don't want there to be a conflict of interest with patient care," said Mandell of University Hospital.
But families often ask doctors about organ donation before anyone approaches them about it, said Geraci, the assistant chief of medicine at the hospital.
"It's an option (families) think they have, and they understand the wishes of their patient," he said. "A lot of the times it's the families that come to this decision."
Which is how it started in Pennsylvania seven years ago. A mother wanted her 14-year-old son to be an organ donor. Though the boy hadn't reached brain death, he was on a ventilator. Organ officials scrambled for transplant experts and ethicists, and recovered the boy's organs without any official policy, said Howard Nathan, chief executive officer for Gift of Life, which coordinates organ donations for eastern Pennsylvania and southern New Jersey.
Gift of Life recovers far more organs from donors without a beating heart than anywhere else in the country; last year 31 people were donors this way.
"It's basically carrying out the wishes of the family," Nathan said. "It doesn't violate laws or ethics. You're still taking organs from a dead person."
Nathan has trained more than 100 hospitals in the area to call the Gift of Life once a patient has an irreversible brain injury. Nathan gets about 110 calls a month from hospitals, and of those, three are usually successful donors without a beating heart.
"The care of the patient doesn't change just because they made that phone call," Nathan said.
Geraci said that's how it will be at University, too.
"The way we care for a patient won't change, but the staff will have to be aware that there are widened options for (organ) donation," Geraci said.
I have no comment.
All the reason more why I won't be an organ donor, unless I can specify (in great detail) the terms under which my organs might be taken.
That includes specifying who can and can't receive them.
Remember the "Sixty Minutes" story about how people donated the tissue from their loved ones---only to find out it had been sold for penile enlargement surgery. At a significant profit to the "insiders" of the "organ donation" charities.
How obscene is this?! I can just see the rush to rip out body parts as soon as they think the heart has stopped.
Any of these ghouls ever heard of resuscitation? Paddles? Give me 300 and clear?!
If the price is right, and as long as it doesn't go to a "domestic enemy of the Constitution", I'd consider it.
Under any other circumstances, it's not "fine" in my book.
Huh? Doesn't this constitute attempted murder?
And who defines an "irreversible" brain injury? Does this mean that they won't rescuscitate patients who flatline? And what's the bit about not using ER or OR "donors?"
This is one wacky article.
Of course, the law prohibits you from "selling" your organs. The only people allowed to profit from your donation are people unrelated to you or your family---like corporation insiders who purchase organs/tissue/bones from the organ bank and then resell them.
I don't blame you for being sceptical about the process.
Which is why there is a shortage.
...but there will be.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.