Professors Argue for Change in Organ Donation Guidelines

Dartmouth Medical School professor James L. Bernat and Harvard Medical School professor Robert D. Truog argued for a change in vital organ donation guidelines on both academic and practical grounds Tuesday afternoon.

At the discussion, “Dead Donor Rule and Future of Organ Transplantation,” Truog advocated that patients need not necessarily be dead before their vital organs are removed for donation. The discussion, which was moderated by Dr. Lisa Lehmann of Brigham and Women’s Hospital, drew around 40 attendees.

According to Bernat, the dead donor rule, which states that vital organ donors must be dead, is the ethical and legal foundation of organ donation. Bernat questioned the observance of the rule in cases of donation after circulatory determination of death. In these cases, patients are declared dead after permanent cessation of circulatory function, which is usually determined by failed CPR attempts. However, auto-resuscitation and recovery may occur up to seven minutes after CPR is abandoned, he said, adding that death should not only depend on physician volition.

Truog argued for the abandonment of the dead donor rule by defining death as the permanent loss of consciousness. With this perspective, brain-dead patients who are still alive as determined by the circulatory-respiratory criterion may qualify as multi-organ donors. He suggested the possibility of organ donation under anesthesia provided that the patient is “permanently unconscious or imminently dying.”

Such an alternative, as controversial as it may seem, presents the advantages of increasing the donor pool and maximizing the quality of organs obtained, Truog said. There is permanent damage inflicted to organs when circulatory function ceases, so the option of operating on donors while they are alive is attractive, he added.

The floor was filled with questions following Truog’s proposition. Both speakers said that the future of death determination for organ donation should be a policy decision made by the public.