title: Observations of withdrawal of life-sustaining treatment from patients who became non-heart-beating organ donors.
abstract: OBJECTIVE
  Non-heart-beating organ donation for transplantation is increasing despite the concern whether all the donors are dead. This concern is based on the adequacy of documentation of death and the appropriate duration that circulation and respiration should be absent before death certification. No studies have examined the documentation and deaths of patients who became non-heart-beating organ donors.
  
  
  METHODS
  Retrospective study of observational data.
  
  
  METHODS
  All non-brain-dead patients who became non-heart-beating organ donors at the University of Pittsburgh Medical Center from January 1, 1993, to June 30, 1998, were identified. Records for 15 of 16 patients were available for review.
  
  
  RESULTS
  Adequacy of documentation, extubation time, onset of severe hypotension, duration of absent circulation before death was certified, and the time of incision for organ procurement were ascertained. Twelve of 15 records had all required clinical documentation. The mean age of patients was 46.5 +/- 5.7 yrs. All 15 patients were extubated before death and had femoral arterial catheters; one had a biventricular assist device discontinued. The time of hypotension and pulselessness was not documented for one and three patients, respectively. All 12 patients with documentation had > or =2 mins of absent circulation. Time from certification to incision for procurement was 1.1 +/- 2.3 mins.
  
  
  CONCLUSIONS
  In a small study of non-heart-beating organ donation, circulation never resumed after >1 min of absent circulation, suggesting that 2 mins of absent circulation is sufficient to certify death. Three of 15 patients had inadequate documentation. Gaps and inconsistencies in documentation may raise concern about the potential for abuse.
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh School of Medicine, the Institute for Quality and Medical Management, University of Pittsburgh Medical Center, PA 15213, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: DeVita
authors.forename: J V
authors.initials: JV
authors.lastname: Snyder
authors.forename: R M
authors.initials: RM
authors.lastname: Arnold
authors.forename: L A
authors.initials: LA
authors.lastname: Siminoff
mesh_terms: D000328:Adult; D001926:Brain Death; D005260:Female; D006321:Heart / Q000502:physiology; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors