When Organ Donors Are Still Patients: Is Premortem Use of Heparin Ethically Acceptable?

DuBois, James M.; Delmonico, Francis L.; D’Alessandro, Anthony M.

doi:10.4037/ajcc2007.16.4.396

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Current Controversies in Critical Care| July 01 2007

When Organ Donors Are Still Patients: Is Premortem Use of Heparin Ethically Acceptable?

James M. DuBois, PhD, DSc;

James M. DuBois, PhD, DSc

James M. DuBois is the Hubert Mäder Chair of Health Care Ethics, center director, and department chair at Saint Louis University, St Louis, Missouri. Francis L. Delmonico is medical director of the New England Organ Bank and a professor of surgery at Harvard Medical School. Anthony M. D’Alessandro is professor of surgery at the University of Wisconsin School of Medicine and executive director of the UWHC Organ Procurement Organization.

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Francis L. Delmonico, MD;

Francis L. Delmonico, MD

James M. DuBois is the Hubert Mäder Chair of Health Care Ethics, center director, and department chair at Saint Louis University, St Louis, Missouri. Francis L. Delmonico is medical director of the New England Organ Bank and a professor of surgery at Harvard Medical School. Anthony M. D’Alessandro is professor of surgery at the University of Wisconsin School of Medicine and executive director of the UWHC Organ Procurement Organization.

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Anthony M. D’Alessandro, MD

James M. DuBois is the Hubert Mäder Chair of Health Care Ethics, center director, and department chair at Saint Louis University, St Louis, Missouri. Francis L. Delmonico is medical director of the New England Organ Bank and a professor of surgery at Harvard Medical School. Anthony M. D’Alessandro is professor of surgery at the University of Wisconsin School of Medicine and executive director of the UWHC Organ Procurement Organization.

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Am J Crit Care (2007) 16 (4): 396–400.

https://doi.org/10.4037/ajcc2007.16.4.396

The “dead donor rule” was established in the context of organ donation to provide a societal assurance that organ recovery would not cause the death of a potential donor.¹ Organs may be recovered for transplantation after death is declared either by a permanent absence of circulation and respiration in the patient or by an irreversible absence of brain function that includes cortical and brainstem activity.

Donation after cardiac death (DCD) involves recovering organs from patients who have been declared dead using circulatory-respiratory (as opposed to neurological) criteria. DCD donors (also known as non–heart-beating donors) are typically ventilator-dependent patients who have suffered devastating head trauma or stroke from an intracranial hemorrhage or anoxia but are not “brain dead.” (On a side note, in 2006 an Institute of Medicine [IOM] committee proposed a change in current terminology to eliminate any implication that only the brain or the heart has died in...

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