Interest in Use of Non-Heart-Beating Donors Growing

A small but growing number of U.S. organ procurement organizations are seeking to deal with the surging demand for organ transplants by encouraging the use of non-heart-beating donors in addition to brain-death donors.

Last year, non-heart-beating donors accounted for just 168 of the 6,081 cadaver organ donors, according to the United Network for Organ Sharing (UNOS). Almost half of the total were handled by just six of the 59 U.S. organ procurement organizations.

But at a time when demand for transplants is surging and cadaver organ donation is at best flat, a number of OPOs are expressing growing interest in working with hospitals to obtain more non-heart-beating donors despite some thorny ethical, medical and technical issues.

Non-heart-beating donation leaves some doctors uneasy because of the need to retrieve the organs very quickly after the heart stops beating -- and the patient has been pronounced dead.

In Pittsburgh, some hospitals wait just two minutes before they begin organ retrieval. Other hospitals wait five minutes after the last heartbeat before proceeding, as recommended by the Institute of Medicine.

Even when moving this quickly, generally only the kidneys -- and sometimes the liver -- remain viable for transplant from non-heart-beating donors. The heart and lungs deteriorate too rapidly after the heart has stopped.

In contrast, the more common form of cadaver donation is based on a declaration of brain death, where a ventilator generally keeps the heart pumping while doctors conduct tests that show no brain function. At that point, the heart, lungs, liver, intestines, kidneys and pancreas are all potentially available for retrieval.

In an era of air bags, seat belts and motorcycle helmets, which OPO directors credit for the diminishing number of brain-death cadavers available for organ donation, many believe non-heart-beating donors are the only real hope of expanding this donor pool.

But the use of non-heart-beating donors seems likely to remain somewhat controversial, as illustrated by an article in the October issue of Playboy headlined "The Heart-Stopping Truth About Organ Donation," in which the author suggests that "what organ donors don't know could kill them."

Other sources: UNOS