Ethical Issues
Certain ethical issues are raised by NHBD transplantation, and require due sensitivity to ensure that ethical standards are maintained.
In category II uncontrolled donors, the donor may die and the transplant team arrive before the donor's next-of-kin can be contacted. It is controversial whether cannulation and perfusion can be started in these circumstances. On one hand, it can be considered a violation of the potential donor's autonomy to cannulate before their in-life wishes are known. On the other hand, delay in cannulation may mean that a patient's strongly held wish to be donor cannot be respected. Many ethicists also feel that a doctor's duty of care to the still living outweighs any duty of care to the dead. The compromise reached is usually to cannulate if there is any evidence of a wish to donate (such as a donor card or registration as a donor) even in the absence of next-of-kin.
For category III donors, treatment is being withdrawn from a living person, who will then die and become a donor. It is important that the decisions that injuries are non-survivable, continued treatment is futile and that withdrawal is in the patient's best interests be made completely independently of any consideration of suitability as an organ donor. Only after such decisions have been firmly made should a patient be considered as a potential organ donor. Although such treatment can be continued until the transplant team arrive, no additional treatment should be started to improve the organs – until the point of death, the patient should be treated exactly as any other dying patient.
In recent years this has been termed Donation after Cardiac Death (DCD) or Donation after Circulatory Determination of Death (DCDD) in the United States, although Non-Heart Beating Donation is the more widely used term internationally. One general classification of donors was recently proposed (2012): DDNP (Deceased Donor with Natural Perfusion) for heart-beating donors (DBD) and DDAP (Deceased Donor with Artificial or Absent Perfusion) for non-heart-beating donors (DCD and ecmo-assisted-DBD).
Read more about this topic: Non-heart-beating Donation
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