USA: Organ Donation after Cardiac Death

Aux USA, on reconnaît actuellement que les patients prélevés "à coeur arrêté" sont mourants et non morts :

"Although the numbers of organ donors and transplantations in the United States have more than doubled over the past 20 years (see line graph), the demand for organs continues to dwarf the supply. In 2006, there were about 29,000 solid-organ transplantations; as of June 2007, there were about 97,000 people on waiting lists for organ transplantation."

"About three of every four organs that are transplanted are recovered from deceased donors. The most rapid increase in the rate of organ recovery from deceased persons has occurred in the category of donation after 'cardiac death' — that is, a death declared on the basis of cardiopulmonary criteria (irreversible cessation of circulatory and respiratory function) rather than the neurologic criteria used to declare 'brain death' (irreversible loss of all functions of the entire brain, including the brain stem). Organs were recovered from 645 donors after cardiac death in 2006, as compared with 189 in 2002; these donors accounted for 8 per cent of all deceased donors in 2006 (...). At the Organ Procurement Organization at the University of Wisconsin, the New England Organ Bank in the Boston area, and the Finger Lakes Donor Recovery Network in New York, such donors accounted for more than 20 per cent of all deceased donors."

Distribution of Deceased Organ Donors in the United States, 1995–2006:
"Organ donors who meet the standard criteria for donation after brain death are usually 59 years of age or younger. The expanded criteria for donation after brain death involve the use of organs from persons more than 60 years old and from persons 50 to 59 years old who have two or three of the following conditions: cerebrovascular accident as cause of death, a serum creatinine concentration of more than 1.5 mg per deciliter (133 µmol per liter), and a history of hypertension. Data are from the Organ Procurement and Transplantation Network.

Obtaining organs from donors after cardiac death — when the heart is no longer beating — is the approach that was generally followed in the 1960s and earlier. Today, such donations typically involve patients who are on a ventilator as the result of devastating and irreversible brain injuries, such as those caused by trauma or intracranial bleeding. Potential donors might also have high spinal cord injuries or end-stage musculoskeletal disease. Although such patients may be so near death that further treatment is futile, they are not dead."

Source:
New England Journal of Medicine (NEJM)
Article by Robert Steinbrook, M.D.