Organ donors sought from cardiac deaths

There is a way to increase organ donations possibly by up to 20%, but it involves a protocol that is not universally practiced.

Now, with 17 people dying daily in the United States waiting for an organ, health officials are pushing hospitals and organ procurement organizations to pursue more donations after cardiac death (DCDs).

DCDs involve donors who have brain injuries but are not considered "brain dead," cannot maintain circulatory or respiratory function and die once life support is withdrawn. Thirty-five of the country's 59 organ procurement organizations have DCD protocols, but 11 of these OPOs had only one or two DCD donors in 2003.

In June, St. Paul-based LifeSource, the organ procurement organization responsible for Minnesota and North and South Dakota, became the latest OPO to adopt DCD policies, and it's expecting this to translate into a 10% to 15% increase in donor rates.

"In the coming years, we'll see most -- if not all -- OPOs adopting these practices," said Gift of Life spokeswoman Susan Mau Larson. "Lives are saved or enhanced by such donations, and donor families find it as something positive coming out of a tragedy. So it helps that way, too."

The U.S. Dept. of Health and Human Services Advisory Committee on Organ Transplantation issued a call for hospitals and OPOs to maximize DCDs in November 2002.

UNOS to review DCD science

Kim Johnson, professional services coordinator for United Network for Organ Sharing, said UNOS reaffirmed its stance that DCDs were "ethically permissible" in November 2000. She said the UNOS Ethics Committee will review the current science involving DCD at its September meeting.

In the early days of organ transplantation, all donations were DCDs, and it was only later that donations moved almost exclusively to patients who had experienced brain death, said Tony D'Alessandro, MD, professor of surgery at the University of Wisconsin in Madison and executive director of the University of Wisconsin Hospitals and Clinics OPO.

"We're going back to the future, so to speak," he said, adding that the Wisconsin OPO never really stopped pursuing DCD.

He said that, at 24% of total donations in 2003, the Wisconsin OPO has the largest percentage of DCDs, with 27 out of 115 total donations, but the Philadelphia-based Gift of Life OPO had the most: 51, which was about 15% of its total of 334 donations.

AMA Council on Ethical and Judicial Affairs member Robert Sade, MD, said estimates of DCDs boosting total organ donations by 20% might be too optimistic because the number of patients who qualify as DCD candidates is not very high. (UNOS estimates there are about 1,000 DCD candidates annually, and organs were recovered from 142 of them in 2001.)

"Nevertheless, the other side of this is that, for any organ you can get, there is someone else whose life is going to be better and a lot longer," said Dr. Sade, a professor of surgery at the Medical University of South Carolina in Charleston. "That alone makes it worthwhile."

The AMA has been a long-time supporter of DCD. In a policy approved in 1994, however, it stressed that the health care team providing end-of-life care must be separate from the transplant team, and decisions to withdraw life support should not be "influenced by the prospect of organ donation."