Ethical Questions and Issues Surrounding Organ Donation

Ethical Question Viewpoint Alternative Viewpoint
How long after loss of circulation can a practitioner declare death? Between 2 and 10 minutes, based on current literature documenting length of time that autoresuscitation has occurred, as long as the decision to allow natural death has been made. Not until the point in time that resuscitative efforts could not restore spontaneous circulation. Currently we do not have evidence to support how long this would be.
Between 7 and 10 minutes after resuscitative efforts have stopped in uncontrolled donation after circulatory determination of death.
Are individuals and surrogates truly and fully informed when consenting for organ donation? Individuals may consent by designating the decision on a driver’s license, in advance directives and wills, or through an online donor registry. If no previous consent by a patient exists, a surrogate will usually have to give consent if the patient is unable. Individuals who consent to organ donation may not understand the dying process or be aware of the ethical dilemmas involved in organ donation.
Are there conflicts of interest? Organ donation should not be considered until the decision has been made to allow natural death and withdraw support. There is perception that those who care for patients and participate in withdrawal decisions are providers who care for organ recipients and may be biased.
Organ procurement teams and transplant surgeons are not to be involved in the decisions or act of withdrawing support or declaring death.
Consent for donation should be requested by a trained individual who is not part of the care team. Some believe that it is impossible to not consider organ donation as decisions to withdraw care are being made and, therefore, could influence the decision to withdraw support.
Should antemortem interventions be performed (eg, administration of heparin, vasodilators, bronchoscopy, cannulating large vessels—all for the purpose of preserving organ function)? If the actual risk to the donor is low and is fully disclosed to patients and families, the procedure is ethically acceptable. There is concern that these procedures pose risks to the donor and benefit only the recipient.
What postmortem procedures are ethically acceptable (eg, procedures such as extracorporeal membrane oxygenation that restore circulation and oxygenation)? Restoring circulation to organs can result in better outcomes of transplanted organs. As long as oxygen and circulation are not supplied to the brain by the procedure, the diagnosis of death is still valid. Procedures that restore oxygenation and circulation are unacceptable because they could reverse death.