"Non-heart-beating," or "cardiac death," organ donation: why we should care.
BACKGROUND
Organ donation after cessation of cardiac pump activity is referred to as non-heart-beating organ donation (NHBOD). NHBOD donors can be neurologically intact; they do not fulfill the brain death criteria prior to cessation of cardiac pump activity. For hospitals to participate in NHBOD, they must comply with a newly introduced federal requirement for ICU patients whose deaths are considered imminent after withdrawal of life support. This report describes issues related to NHBOD.


METHODS
A nonstructured review of selected publications and Web sites was undertaken.


RESULTS
Scientific evidence from autoresuscitation and extracorporeal perfusion suggests that verifying cardiorespiratory arrest lasting 2-5 minutes does not uniformly comply with the dead donor rule, so that the process of organ procurement can be the irreversible event defining death in organ donors. The interest of organ procurement organizations and affiliates in maximizing recovery of transplantable organs introduces self-serving bias in gaining consent for organ donation and abandons the basic tenet of obtaining true informed consent. The impact of donor management and procurement protocols on end-of-life (EOL) care and the potential trade-off are not disclosed, raising concern about whether potential donors and their families are fully informed before consenting to donation.


CONCLUSIONS
The use of comprehensive quality indicators for EOL care can determine the impact of NHBOD on care offered to donors and the effects on families and health care providers. Detailed evaluation of NHBOD will enable the public to make informed decisions about participating in this type of organ donation.
Rady
Mohamed Y
MY
Department of Critical Care Medicine, Mayo Clinic Hospital, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. rady.mohamed@mayo.edu
Verheijde
Joseph L
JL
McGregor
Joan
J
D003643:Death; D003657:Decision Making; D006801:Humans; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods; D013727:Terminal Care / Q000592:standards; D020458:Third-Party Consent / Q000331:legislation & jurisprudence; D014019:Tissue Donors / Q000331:legislation & jurisprudence*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence* / Q000592:standards*; D014481:United States