Retrieving organs from non-heart-beating organ donors: a review of medical and ethical issues.
OBJECTIVE
The increasing gap between numbers of individuals awaiting organ replacement surgery and the supply of organs available for transplant underpins attempts to increase the number of organs available. One practice, used in other countries, is the recovery of organs from non-heart-beating organ donors (NHBD). The purpose of this review is to discuss ethical issues surrounding the use of organs from these donors.


METHODS
Narrative review from selected Medline references, and other published reports.


RESULTS
NHBD protocols have been established in many countries including the United States. Despite numerous publications, and extensive debate in the literature, significant ethical issues remain unresolved in the retrieval of organs from donors that have died from cessation of cardiac activity. The ethical concerns primarily arise in the determination of death, the tension between the time constraints on recovering organs viable for transplantation, and procedures to enhance organ viability. Despite a concerted effort in the United States, less than half of the organ procurement organizations have NHBD protocols.


CONCLUSIONS
Canadian centres can learn from the difficulties encountered in other centres that have developed NHBD protocols. A moratorium on Canadian NHBD protocols should be considered until a National consensus reflecting Canadian values has been undertaken.
Doig
Christopher James
CJ
Department of Critical Care Medicine and The Office of Medical Bioethics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. cdoig@ucalgary.ca
Rocker
Graeme
G
D001926:Brain Death; D006323:Heart Arrest; D006801:Humans; D012297:Right to Die; D014019:Tissue Donors / Q000941:ethics*; D020858:Tissue and Organ Harvesting / Q000145:classification / Q000941:ethics* / Q000379:methods; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000458:organization & administration