USA: Organ-donor unease (DCD: Donation after Cardiac Death)

"Denver and the west - Patients partly brain-dead are growing source. While some ethicists say the option blurs the line between near-death and death, the demand is there.

Organ donations from partially brain-dead patients - a controversial source - jumped tenfold in Colorado and Wyoming last year, the group that coordinates donations said.

This group of donor patients rose to 20 last year from two in 2004. Those 20 donors, each of whom is considered one donation, provided 36 organs - primarily kidneys and livers, according to Sue Dunn, chief operating officer of Donor Alliance, which oversees donations in the two states.

The procedure, however, has some ethicists worried that it blurs a line between death and near-death.

Stuart Youngner, chair of the bioethics department at Cleveland's Case Western Reserve University's medical school, questioned whether it pushed 'the dead-donor rule to the limit.'

Even transplant surgeons say the procedure, called 'donation after cardiac death,' is not the best way to get organs because they may deteriorate more quickly due to lack of blood flow.

'It's not a perfect circumstance for donation,' said Dr. Igal Kam, chief of transplantation at the University of Colorado Hospital.

The technique is being used, however, because of the growing demand for organs.

As of Wednesday, more than 90,000 people in the United States - including 1,500 in Colorado - were awaiting organs, according to the national Organ Procurement and Transplantation Network.

Many people wait months or even years for an organ. On average, 18 people on waiting lists die every day, according to donation organizations.

'Without the shortage of organs, we would never embark on this option,' Kam said. 'But when you have patients on waiting lists who are dying, you need to offer them as many options as we can.'

In the most widely accepted method, a patient is eligible to donate organs after being declared brain-dead.

But with donation after cardiac death, a patient need only be partially brain-dead. The brain stem, which performs very basic functions, such as keeping the heart beating, can still be active.

Partially brain-dead patients are usually hooked to a breathing machine, and when that machine is disconnected, respiration and the heart stop.

The method made headlines last year, when Montrose County Coroner Mark Young ruled that doctors had removed a man's organs before he was legally dead.

Young, who later backed off his assertion, acknowledged that the man, who had shot himself in the head, could not have survived the wounds.

Overall donation was up in Colorado and Wyoming last year, Donor Alliance reports.

There were 125 total organ donors in 2005, a 25 percent increase over 2004's total of 100.

The alliance reported 725 tissue donors in 2005, up 21 percent from 601 donors in 2004.

Hearts and lungs are rarely used from partially brain-dead patients, due to fears they have been damaged by lack of blood. Still, those organs have occasionally been transplanted after cardiac death, and researchers are studying whether they could be more widely used, Dunn said.

Initially, organ donations were done in the moments after a heart stopped beating. But with increased use of ventilators in the late 1960s, brain death became the standard threshold for organ donation.

That began to change in the 1990s, as families sought to donate a loved one's organs but couldn't because the patient wasn't brain-dead, said Amy Iveson, a Donor Alliance vice president.

Still, the procedure raised questions. In 1997, Youngner co-wrote a paper arguing the cardiac-death method took advantage of 'ambiguities in the criteria and definition of death.'

In 2000, the Institute of Medicine tried to settle the questions by setting criteria and protocols for obtaining organs through cardiac death.

The institute wrote that the heart must stop beating and the 'cessation must be irreversible,' said Margaret Allee, chairwoman of United Network for Organ Sharing's ethics committee.

The Donor Alliance's Iveson said most Colorado hospitals performing transplants have used cardiac-death organs. And some who once criticized the procedure have backed down.

Even Youngner now hedges on criticizing the procedure. 'I have some philosophical quibbles,' he said. 'But even if you grant that I am right, I wouldn't say doing it is wrong.'

Dunn estimated that last year's number of cardiac-death donations probably put Donor Alliance in the top 20 percent nationwide.

Among leading regions using cardiac-death donations in 2005 were Massachusetts-based New England Organ Bank, which reported 44 in its fiscal year ended June 30, and Pennsylvania- based Gift of Life, which reported 46."

Source:
By Karen Augé
Denver Post Staff Writer
DenverPost.com