New Trend in Organ Donation Raises Questions

The National Academy of Sciences' Institute of Medicine examined the practice, however, and concluded that it is ethical as long as strict guidelines are followed, including making sure that the decision to withdraw care is independent of the decision to donate organs and that surgeons wait at least five minutes after the heart stops.

"People are dying on the waiting list," said Francis L. Delmonico, a transplant surgeon at Harvard Medical School, speaking on behalf of the United Network for Organ Sharing. More than 95,000 Americans are waiting for organs. "This is vital as an untapped source of organ donors."

Nancy Erhard's 25-year-old son, Bo, became a DCD donor at Massachusetts General Hospital in Boston in November 2005 after a burst artery caused devastating brain damage.

"There was no hope. He would never regain conscious thought," Erhard said. "This gave his life so much more meaning in the end because he was able to help so many others."

While some doctors and ethicists who initially questioned the practice have become more comfortable with the procedure, others remain troubled.

"The image this creates is people hovering over the body trying to get organs any way they can," said Michael A. Grodin, who directs Boston University's Bioethics and Human Rights Program. "There's a kind of macabre flavor to it."

Some say the practice can interfere with patients' dying peacefully, surrounded by loved ones, and can deny the family sufficient time to grieve. Many hospitals have responded by withdrawing life-support devices and other care in the intensive-care unit or allowing families to accompany loved ones to the operating room so they can be at the bedside when death occurs.

But many experts remain concerned and worry that the practice blurs the definition of death.

"The person is not dead yet," said Jerry A. Menikoff, an associate professor of law, ethics and medicine at the University of Kansas. "They are going to be dead, but we should be honest and say that we're starting to remove the organs a few minutes before they meet the legal definition of death."

In response to such concerns, most doctors wait five minutes after the heart stops before pronouncing patients dead. But doctors at some hospitals wait three minutes, others two. In Denver, surgeons at Children's Hospital wait 75 seconds before starting to remove hearts from infants, to maximize the chances that the organs will be useable.

"A lot of us are not particularly happy about cutting that line particularly close," said Gail A. Van Norman, an anesthesiologist and bioethicist at the University of Washington in Seattle.

Van Norman and others also worry that the practice could pressure family members and doctors to discontinue care, perhaps before it is undeniable that there is no hope. Those fears are particularly acute in pediatric intensive-care units, where the same nurses and doctors frequently care for both potential donors and potential recipients.