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BJA Advance Access published online on December 10, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei048
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Accepted September 10, 2004

Case Report

Non-heartbeating organ donation: clinical process and fundamental issues

M. D. D. Bell 1*

1 The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK

* To whom correspondence should be addressed.
M. D. D. Bell, E-mail: dominic.bell{at}leedsth.nhs.uk


  Abstract

This case report outlines the clinical process whereby a patient with severe traumatic brain injury became a non-heartbeating organ donor after a withdrawal-of-care decision. This process raises a series of ethical questions regarding decision-making on grounds of futility, the role of the next of kin, informed consent, the accommodation of manoeuvres directed towards organ retrieval at maximal viability, and the timing and determination of death. Although many aspects of the process can be accommodated within fundamental ethical principles and a broad interpretation of the concept of the ‘best interests’, the variance with established law requires authoritative clarification if a need for transplantable organs is to be responded to without compromising the reputation of practitioners involved in this area of care. Therefore, this recruitment strategy warrants wide public and professional debate to achieve longer-term sustainability and ensure the protection of all parties.

Keywords: complications, death; organ donation, consent; organ donation, futility; organ donation, legal problems.
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