The case for kidney donation before end-of-life care.
Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor's death, this approach satisfies the dead donor rule. The donor family's wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives.
Alpert Medical School of Brown University, Providence, RI 02903, USA. pmorrissey@lifespan.org
Paul E
PE
Morrissey
D000062:Accidents, Occupational; D000328:Adult; D001930:Brain Injuries / Q000209:etiology / Q000601:surgery; D056424:Decompressive Craniectomy; D005190:Family; D006801:Humans; D016030:Kidney Transplantation / Q000941:ethics; D016031:Liver Transplantation / Q000941:ethics; D019520:Living Donors; D008297:Male; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D009392:Nephrectomy / Q000941:ethics*; D016377:Organ Transplantation / Q000941:ethics*; D011639:Public Opinion; D012121:Respiration, Artificial; D013727:Terminal Care / Q000941:ethics*; D020458:Third-Party Consent / Q000941:ethics; D020858:Tissue and Organ Harvesting / Q000941:ethics* / Q000379:methods; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000639:trends; D035502:Trust; D006113:United Kingdom; D014481:United States; D028761:Withholding Treatment / Q000941:ethics*