title: Ethical and legal implications of elective ventilation and organ transplantation: "medicalization" of dying versus medical mission.
abstract: A critical controversy surrounds the type of allowable interventions to be carried out in patients who are potential organ donors, in an attempt to improve organ perfusion and successful transplantation. The main goal is to transplant an organ in conditions as close as possible to its physiological live state. "Elective ventilation" (EV), that is, the use of ventilation for the sole purpose of retrieving the organs of patients close to death, is an option which offsets the shortage of organ donation. We have analyzed the legal context of the dying process of the organ donor and the feasibility of EV in the Italian context. There is no legal framework regulating the practice of EV, neither is any real information given to the general public. A public debate has yet to be initiated. In the Italian cultural and legislative scenario, we believe that, under some circumstances (i.e., the expressed wishes of the patient, even in the form of advance directives), the use of EV does not violate the principle of beneficence. We believe that the crux of the matter lies in the need to explore the real determination and will of the patient and his/her orientation towards the specific aim of organ donation.
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome Sapienza, Viale Regina Elena 336, 00161 Rome, Italy ; Neuromed, Istituto Mediterraneo Neurologico (IRCCS), 86170 Isernia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Frati
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome Sapienza, Viale Regina Elena 336, 00161 Rome, Italy.
authors.forename: Vittorio
authors.identifier: 0000-0002-1686-3236
authors.initials: V
authors.lastname: Fineschi
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome Sapienza, Viale Regina Elena 336, 00161 Rome, Italy.
authors.forename: Matteo
authors.identifier: 0000-0002-0146-1314
authors.initials: M
authors.lastname: Gulino
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome Sapienza, Viale Regina Elena 336, 00161 Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Montanari Vergallo
authors.affiliation: Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome Sapienza, Viale Regina Elena 336, 00161 Rome, Italy.
authors.forename: Natale Mario
authors.initials: NM
authors.lastname: Di Luca
authors.affiliation: Department of Legal Medicine, University of Foggia, Ospedale Colonnello D'Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Turillazzi
mesh_terms: D003643:Death; D006801:Humans; D062528:Medicalization / Q000941:ethics / Q000331:legislation & jurisprudence; D016377:Organ Transplantation / Q000941:ethics / Q000331:legislation & jurisprudence; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000331:legislation & jurisprudence