You're covering a medical unit and have a patient on your ward team who's terminal. He's rapidly deteriorating and expected to expire soon. His heart continues to have irregular rhythms and is the patient is expected to go into asystole soon. He has made it known repeatedly he wants to be "DNR"
(do not resuscitate) and wishes to donate his organs. There's a patient who is a perfect tissue match for your patient's kidney. The intern raises some ethics issues regarding this patient, esp. not wanting to hasten his demise in order to harvest a kidney so another patient may live.

What ethical issue(s) should you address?
 

Every hospital should have an ethics committee and/or advisors to help with these kinds of decisions. It's required by JCAHO (RI - Patient rights and organizational ethics) and everyone should know how to contact them. Since ethics committees are multidisciplinary, you may be asked to participate in this process, even if you're not a physician. Many ethics committees require non-medical folks be members of the decision making/opinion generating body.

The local ethics committee was asked to comment on the ethical implications of three issues pertaining to Non-Heart Beating Organ Donation.  The consensus answers achieved were based upon research of the literature, survey of national and community standards, and application of bioethical principles from individual committee member professional viewpoints.

1.   Who declares the patient dead? 

"Pronouncement of death will occur in accordance with local hospital instruction(s).  The physician certifying death must not be involved in either procuring organs or the care of the transplant recipient." This helps eliminate any conflicts of interest. How would it look if the organ recipient's physician declared the patient dead and immediately harvests the organ to be donated?

2.   Should heparin be used to optimize organ function, even if it may hasten death?  

"Interventions intended to preserve organ function are permitted when, in the opinion of the donor patient's primary physician, they will not cause undue discomfort or hasten death." Heparin is sometimes used to maintain an organ's viability. The question was should it be used if the organ saving intervention (heparin) might hasten the patient's demise.

3.   Should there be a waiting period after the declaration of death before organs are harvested?

"Two minutes must transpire after declaration of death before organ procurement can begin."

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