There appear to be three schools of thought
about organ transplants based on Donation after Cardiac Death – removing organs
after the heart stops beating but before electrical activity ceases in the
brain. The patient is dead; the patient is not dead but this doesn’t matter;
and the patient is not dead and this matters so much that DCD should stop.
Nearly all transplant surgeons support the first option. However, vocal dissenters
in the third option surfaced this week.
Writing in the journal Pediatric Critical
Care Medicine, eight doctors argue that there should be a moratorium on DCD, at
least for children. The public is being misled, they say. “I think that we’re
being less than entirely honest about when the patient is truly dead,” Dr. Ari
Joffe, of Stollery Children’s Hospital in Edmonton, Canada, told the National Post.
“We’re not trying to deny the parent the choice to donate… The point we’re
making is ‘what if they’re almost dead and we’re not sure if they’re dead, and
it’s not at the point of irreversibility yet?’ ”
Dr Joffe and his colleagues recognize that
they are in a minority. But they cite several reasons why DCD is not reliable, including
reports of recovery after the heart stopped beating for 5 to 10 minutes and the
fact that brain death occurs 10 to 15 minutes after DCD. Furthermore, they
worry that the need for organs will tempt doctors to put the social good of
increasing the supply of organs above the welfare (and life) of their patients.
Critical Care Medicine,
donation after cardiac death
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