Correspondence

Transplantation of Kidneys from Donors Whose Hearts Have Stopped

N Engl J Med 1998; 339:48July 2, 1998

Article

To the Editor:

The article by Cho et al. (Jan. 22 issue)1 on the transplantation of kidneys from donors whose hearts have stopped beating raises serious ethical questions about this procedure. For those of us who maintain that causing death by removing life support is tantamount to euthanasia,2-5 the procedure is unethical. However, even for those who have no qualms about removing life support from certain patients, the ethics of the procedure are questionable. In what cases, if any, can life support be removed for the purpose of obtaining organs for donation? Is it enough to obtain permission from family members who are under stress?

William J. Burke, M.D., Ph.D.
Saint Louis University, St. Louis, MO 63110-0250

5 References

1. 1

   Cho YW, Terasaki PI, Cecka JM, Gjertson DW. Transplantation of kidneys from donors whose hearts have stopped. N Engl J Med 1998;338:221-225
   Full Text | Web of Science | Medline

2. 2

   Burke WJ. The dying patient. Neurology 1996;47:1611-1612
   Web of Science | Medline

3. 3

   Orentlicher D. The Supreme Court and physician-assisted suicide -- rejecting assisted suicide but embracing euthanasia. N Engl J Med 1997;337:1236-1239
   Full Text | Web of Science | Medline

4. 4

   Quill v. Vacco, 80 F 3d 716 (2d Cir. 1996).
   

5. 5

   Pontifical Council for Pastoral Assistance. Charter for health care workers. Boston: Pauline Press, 1995:105.
   

Author/Editor Response

The authors reply:

To the Editor: Removal of life support is something that everyone views as a momentous step for patients, their families, and their physicians. Dr. Burke's letter implies that whenever the removal of life support is accompanied by organ donation, the patient's wishes or the family's decision to offer the organs should be questioned because of perceived conflicts of interest. In the United States, safeguards have been established in the past 25 years to ensure that the physicians who care for patients and who declare them dead are not the physicians who obtain organs for transplantation. Additional safeguards, such as those instituted at the Washington Hospital Center, Washington, D.C.,1 can further ensure ethical treatment of patients and their next of kin when life support is removed.

In our article, we reported that the success rates for transplantation of kidneys from donors whose hearts had stopped beating were similar to the success rates with the use of kidneys from donors who were brain-dead but whose hearts were still beating. We hope these results will encourage the transplantation community to explore the ethical issues raised by Dr. Burke, as well as the practical issues involved in developing appropriate review procedures and prolonging the period of organ viability after cardiac death. Statutes already exist in Florida, Virginia, and the District of Columbia that allow the initiation of in situ organ preservation while the next of kin are located to discuss donation. With continued vigilance, the number of patients who will benefit by receiving organs from donors whose hearts have stopped beating can be increased, as can the number of families who find some comfort in their loss through organ donation.

Yong W. Cho, Ph.D.
J. Michael Cecka, Ph.D.
Paul I. Terasaki, Ph.D.
UCLA Tissue Typing Laboratory, Los Angeles, CA 90095-1652

1 References

1. 1

   Kowalski AE, Light JA, Richie WO, Sasaki TM, Callender CO, Gage F. A new approach for increasing the organ supply. Clin Transplant 1996;10:653-657
   Web of Science | Medline