Brain Death vs. Cardiac Death in Organ Donors

A recent article in The Washington Post titled Infant Heart Transplant Controversy Continues reports the results of recent heart transplant surgeries using hearts from donors who experienced cardiac death.

We're familiar with organ donation after a patient has been declared brain dead. However, organs can also be used for transplantation after a patient experiences cardiac death--after life support is withdrawn, the heart stops. The controversy lies in how long after the heart stops beating before it is permissible to begin harvesting organs, especially the heart itself. Previously, the Institute of Medicine had recommended waiting 5 minutes in case the heart were to restart on its own. However, it has been recently suggested that cardiac death might be irreversible after only 1 minute.

Surgeons at a Denver hospital have recently reported results from heart transplantation surgery in 3 infants where the time between the heart stopped and organ retrieval started was 3 minutes in one case and 75 seconds in the other two cases. By decreasing the amount of time that the organs are deprived of oxygen likely increases the success of the transplantation procedure.

Ethicists argue that if a heart is transplanted from one patient into another and resumes functioning, then it is not possible for the first patient to have suffered from irreversible loss of cardiac function. Others agrue that in the case of these patients, none of them would die as a result of removal of their vital organs who would not have otherwise died after withdrawal of life support.

How and when questions about organ donation are raised at issue as well? One patient's death should not be hastened in order to save the life of another. Ethically, health care providers should not raise the issue of organ donation with the family until the decision has been made to withdraw life support. With this decision made, if the family then consents to organ donation, then perhaps more lives can be saved by increasing the number of available donor organs.