A recent paper, “Transplantation of the heart after circulatory death of the donor: time for a change in law?” engaged my attention. Even though harvesting donor organs and working with donor recipients is a specialty area we are all aware of the efforts being made to increase the numbers of donors in Australia.
The paper discussed in relation to heart donation the difference between brain death and circulatory death. The key is it must be established that there is irreversible brain death or irreversible circulatory death. Either supports the removal of donor organs. What was raised in this paper was for heart removal it was always the case until recently, this only occurred if irreversible brain death was established.
The clinical fact is in Australia two adults were transplanted with hearts procured after circulatory death in 2014. In those cases, the donor hearts were reanimated and kept beating and warm inside a container pending transplantation. The legal issue raised was whether heart transplantation after circulatory death of the donor conforms to the dead donor rule in legislation.
The whole legal argument will rest with lawyers and legislators but as a clinician who has worked in situations where donation was an issue and supporting families it did seem to me that this was a can of worms. Thinking about it I wondered how a family might feel if their loved one was pronounced death after heart cessation and then they were asked to agree to donation for that same heart now deemed healthy enough for donation.
”How come if it was broken and the cause of death, this same heart is suddenly fixable and can serve someone else. If it is fixable, then get on with it, save my loved one” would be my personal response faced with this situation.
To be fair, the authors explored (in far more erudite language) this type of reaction as well as the current legislation defining death and regulating organ donation. They concluded that heart transplantation after circulatory death does not conform to present statute law in spite of the fact it has occurred here and overseas. So there is a real medical and ethical dilemma that now relies on law makers to resolve through legislation. After so much effort to promote organ donation and the number of people in need of a heart transplant it would be a tragedy if folk got the idea that organs were taken illegally when in fact the procedures were medically sound and justified. A good example of how the pace of science and technology moves so much faster than the law.