Abstract
Citing a growing donor-shortage crisis, the U.S. organ transplant community has been actively seeking new sources of transplantable organs in recent years. With progress in immunology and transplant-surgery techniques, the number of patients on organ waiting lists has outstripped the supply of available organs from brain-dead donors. In reaction, some medical institutions have begun procuring organs from people whose hearts have stopped beating but who are not technically brain-dead. Although a sort of non-heart-beating donation system was used in the U.S. back in the 1960s and 70s when brain-dead donors were not widely available, today's NHBD is different in one respect - they are ventilator-dependent. In addition, current NHBD protocols vary from one medical institution to another in such key areas as criteria for the declaration of death and pre-death medical interventions, indicating fundamental scientific and ethical principles including the determination of death vary. At one medical institution, its protocol says that surgeons should wait two minutes after the donor's heart has stopped beating before making an incision to procure organs, while protocols at other institutions say it should be five minutes. Some experts are opposed to the NHBD system, questioning whether the brains of such donors are dead at the time of organ procurement. They say that the system may violate the dead-donor rule. They also raise concerns that it is prone to be abused at a time when standards for patients care during withdrawal of life-sustaining therapy are evolving and continuing to be debated and studied, and it could compromise the care of the dying individual. Transplant surgeons in the U.S. seem to have started "managing" death to obtain organs.
