[1] Donors after brain death (DBD) (beating heart cadavers), however, led to better results as the organs were perfused with oxygenated blood until the point of perfusion and cooling at organ retrieval, and so NHBDs were generally no longer used except in Japan, where brain death was not legally or culturally recognized, until very recently.
Tissue donation (corneas, heart valves, skin, bone) has always been possible for NHBDs, and many centres now have established programmes for kidney transplants from such donors.
Category III donors are patients on intensive care units with nonsurvivable injuries who have treatment withdrawn; where such patients wished in life to be organ donors, the transplant team can attend at the time of treatment withdrawal and retrieve organs after cardiac arrest has occurred.
[citation needed] Maastricht definitions were reevaluated after the 6th International Conference in Organ Donation held in Paris in 2013 and a consensus agreement of an established expert European Working Group on the definitions and terminology were standardized, and later the word "retrieved" (organ) was substituted for "recovered" throughout the text.
[citation needed] Livers and lungs for transplant can only be taken from controlled donors, and are still somewhat experimental as they have only been performed successfully in relatively few centres.
[citation needed] Lectures are held by experts on the most challenging themes such as clinical outcomes of transplantation of controlled and uncontrolled DCD organs, progress made on machine perfusion of kidneys, livers, lungs and hearts and ethics and legal issues regarding donation after cardiac death.
A stand-off period is observed after cessation of CPR to confirm that death has occurred; this is usually from 5 to 10 minutes in length and varies according to local protocols.
[full citation needed] Certain ethical issues are raised by NHBD transplantation such as administering drugs which do not benefit the donor,[12] observance of the Dead-donor Rule, the decision-making surrounding resuscitation, the withdrawal of life-support, the respect for a dying patient and the dead body, as well as proper information for the family.
[13] In 2016 author Dale Gardiner issued a report called "How the UK Overcame the Ethical, Legal and Professional Challenges in Donation After Circulatory Death".
Important factors for assessment include A) that the decisions regarding nonsurvivable injuries are correct, B) continued treatment is futile and C) that withdrawal is in the patient's best interests be made completely independently of any consideration of suitability as an organ donor.
[full citation needed] The standard recommendation to ensure this is to require a complete separation of the treatment and organ procurement teams.
This raises the question: Would prejudice about vulnerable patients, such as disabled people, lead medical professionals to approach such individuals and families for NHBD more than others with higher "quality of life" ratings?
[17] The IOM in 2000 concluded that "existing empirical data cannot confirm or disprove a specific interval at which the cessation of cardiopulmonary function becomes irreversible.
Whether it does or not depends on whether we think this requires that people be dead in the ordinary sense of the word or in a legal or some other understanding of it, and writers are lined up on both sides of this issue.
Re: (3) physicians may inappropriately withhold sufficient sedative or analgesic medication to avoid the appearance of euthanasia or in order to improve organ viability.
The process of obtaining donation consent and subsequent donor management protocols for DCD deviate from some of the quality indicators recommended for optimal EOL care.
Organ-focused behaviour by professionals requesting consent for organ donation and ambivalent decision making by family members increase the risk of relatives of deceased donors subsequently developing traumatic memories and stress disorders.
The processes required for the successful accomplishment of donation consent and subsequent organ recovery can interfere with many of the interventions that lessen the burden of bereavement of relatives of ICU decedents.
Potts et al. on behalf of the IOM reply that informed consent does not require this level of disclosure: "Reviewing with interested family members that all brain activity may not have ceased at the exact moment that death is pronounced may be appropriate in some circumstances, but, for many families confronted with such overwhelming emotional matters, knowledge that death has been pronounced is what is paramount.
The sensitivity and skill of the physicians and nurses to the individual needs of families is the key factor whether or not organ donation is involved.
"[32] On the issue at hand, Menikoff and Brock think that the importance of informed consent should put us on the "truth" side of the question.
For example, providing ECMO (Extra Corporeal Membrane Oxygenation) to donors immediately after death is declared by cardiocirculatory criteria can keep organs in their freshest possible condition.
To handle them Bernat recommends that a committee be set up: "A consensus-driven oversight process should determine whether investigational protocols reflect appropriate medical treatment and whether their translation into accepted clinical practice is sound public policy.
These boundaries should be based on scientific data and accepted principles and should be demarcated conservatively to maintain public confidence in the integrity of the transplantation enterprise.
the central question to trigger organ retrieval, the proposal is to shift the focus to obtaining valid consent from patients or surrogates and the principle of nonmaleficence.
Qualified individuals who had given their consent could simply have their organs removed under general anesthesia without first undergoing an orchestrated withdrawal of life support.
Because there will now be no necessary interval between pulselessness and the declaration of death, there can be a reduction in warm ischemia time, and so an improvement in the quality and quantity of transplantable organs.
[37] It will also be possible to give the donor drugs such as heparin and phentolamine, which can hasten death but also maximize organ preservation.
Finally, it will eliminate the possibility that patients will experience discomfort as they are withdrawn from ventilator support by allowing potentially fatal doses of morphine that are not titrated to signs of distress.
[38][39] Thus the question can be posed: "Given the difficulties our society is likely to experience in trying to openly adjudicate these disparate views [of accepting or rejecting the prohibition on physicians killing for transplantation], why not simply go along with the quieter strategy of policy creep?