The proposed changes by the United Network for Organ Sharing, the Richmond nonprofit organization that coordinates organ donation under a contract with the federal government, are part of the first major overhaul of the 2007 guidelines governing “donation after cardiac death,” or DCD, which accounts for a small but growing percentage of donations each year.
Proponents say the changes strengthen the transplant system by aligning the rules with other regulatory bodies and better ensure that the wishes of donors and their loved ones are honored without sacrificing necessary protections.
“The ultimate goal is to facilitate the dying wishes of patients who wish to be donors and save the lives of the 112,000-plus patients who are in need,” said Charles Alexander, the immediate past president of UNOS. “We are always very aware of our public trust.”
Critics, however, say the move heightens the risk that potential donors will be treated more like tissue banks than like sick people deserving every chance to live, or to die peacefully.
“This is another step towards this idea of hovering, hovering, hovering to get more organs,” said Michael A. Grodin, a professor of health law, bioethics and human rights at Boston University. “The bottom line is that they want to do everything they can to increase organ donation.”
The 16-page proposal, which has resurrected the knotty debate over what it means to be dead, was drafted over a year by the 22-member UNOS organ procurement organization committee. It was posted for public comment for about three months, a period that ended June 10. The UNOS board will convene Nov. 14 and 15 in Atlanta to finalize the revisions, which include officially shifting the guidelines from “model elements” to “requirements.”
“We want the process to happen the way it’s supposed to happen to avoid any questions or problems,” Alexander said.
DCD involves surgeons taking organs within minutes of respirators and other forms of life support have being cut off from hospitalized patients who still have at least some brain activity. DCD had been the norm for organ donors before neurological criteria — “brain death” — became the standard in the early 1970s. Since then, most donors have been brain-dead.
But as the number of people needing transplants rose, doctors in the 1990s began reviving what was then called “non-beating heart” donation. DCD has become a growing source of organs as the gap between the number of patients waiting for transplants and the number of available organs has widened. About 6,000 Americans succumb each year while waiting for donated organs.