New Trend in Organ Donation Raises Questions

While many hospitals are adopting DCD policies, others have delayed because of objections. Some are opting out. One hospital chain went ahead but then instituted a moratorium because of concerns that the local organ bank was becoming too aggressive.

In addition to giving DCD donors morphine, valium and other drugs to make sure they do not suffer as life support is withdrawn, doctors often insert a large tube into an artery and inject drugs such as the blood thinner heparin to help preserve the organs. Some say those measures may hasten death.

"It's worrisome when you stop thinking of the person who is dying as a patient but rather as a set of organs, and start thinking more about what's best for the patient in the next room waiting for the organs," Van Norman said.

In California, police and state medical authorities are investigating whether doctors did anything to speed the death of a donor in San Luis Obispo last year.

David Crippen, a University of Pittsburgh critical-care specialist, asked, "Now that we've established that we're going to take organs from patients who have a prognosis of death but who do not meet the strict definition of death, might we become more interested in taking organs from patients who are not dead at all but who are incapacitated or disabled?"

One fear among health experts is that such concerns will discourage people from signing organ-donor cards.

Supporters, however, argue that hospitals have stringent safeguards are in place. Each case is reviewed by an independent panel, and the decision to withdraw care is separated from the decision to become a donor. They also argue that DCD patients meet the legal definition of death because there is no intention of reviving them, and that there is no evidence that anything done to the donors hastens their deaths.

"We are saying that if it is feasible and we can do it in a way that does not harm the patient, then we should do this," said Michael A. DeVita, a professor of internal and critical-care medicine at the University of Pittsburgh. "We believe it's the right thing to do for the patients who want to donate and for those who need organs."