The non-compliance of clinical guidelines for organ donation with Australian statute law.
Organ procurement is possible under statutes defining death as either irreversible cessation of all functions of the brain or irreversible cessation of the circulation, thus fulfilling the "dead donor rule". However, present practice does not conform strictly to these conditions. Clinical guidelines for the diagnosis of whole-brain death are equated, with coma, to absence of brain-stem reflexes which essentially means the absence of spontaneous respiration which is clinically interpreted as "dead enough" or "as good as dead" for the purpose. Moreover, Krommydas v Sydney West Area Health Service [2006] NSWSC 901 suggests public distrust of brain-stem reflexes as tests to diagnose whole-brain death. Mandatory adoption of a test of brain blood circulation, at present optional, would strengthen reliability of the diagnosis. Organ procurement is performed after cessation of the circulation following orchestrated withdrawal of futile life-support and is commenced when the heart fails to "auto-resuscitate" two minutes after it stops, rather than proven irreversible cessation. Ante-mortem procedures are performed on the donor to increase organ availability and viability but may contribute to or cause death. State and national ethical guidelines on this practice conflict and it appears proscribed under State guardianship legislation which requires actions in the best interests of the donor, not the recipient. Considerations should be given to organ procurement in situations where the donor is dying or in which survival is impossible. Simple abandonment of the "dead donor rule", however, is not feasible since organ procurement would be the direct cause of death.
Tibballs
James
J
Royal Children's Hospital, Melbourne. james.tibballs@rch.org.au
D001315:Australia; D001926:Brain Death / Q000175:diagnosis / Q000331:legislation & jurisprudence; D006801:Humans; D009520:New Zealand; D017410:Practice Guidelines as Topic; D014019:Tissue Donors / Q000331:legislation & jurisprudence*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence*