Non-Heart-Beating Organ Transplantation Practice and Protocols (2000) / Chapter Skim
Currently Skimming:
2 Non-Heart-Beating Donation and End-of-Life Care
2 Non-Heart-Beating Donation and End-of-Life Care
Pages 16-26
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 16... ...
Recommendation 3: As recommended in the 1997 IOM report, statistically valid, observational studies of patients after the cessation of cardiopulmonary function need to be undertaken by appropriate experts. These studies should address the following: · conditions under which cardiac autoresuscitation might occur and at what intervals, · signs, symptoms, and testing technologies that could guide the determination of death by irreversible cardiopulmonary function, and · assessment of various technological and clinical observations of the degree and permanence of loss of brain function in whole or in part following the cessation of cardiopulmonary function.
|
From page 17... ...
Empirical research should be undertaken to address concerns about the determination of death. The five-minute time interval between cardiopulmonary arrest and the declaration of death recommended in the 1997 IOM report is a considered judgment based on the available data and on expert interpretation of these data.
|
From page 18... ...
The committee was concerned that the terminology of "cardiac death" and "brain death" might contribute to doubts or misunderstandings about whether and when death "really" takes place. This report uses the terms "death established by neurological criteria" and "death established by cardiopulmonary criteria." It describes the organ and tissue donation process as "non-heart-beating donation," and the patient as a "nonheart-beating donor." Although these terms are more familiar to health care professionals than to the general public, the committee judged them to be more accurate than the simpler terminology of "brain death" and "cardiac death" for conveying when and how death is determined.
|
From page 19... ...
Legally, the right to refuse unwanted medical intervention is based on the common law right to bodily integrity, the constitutional right to privacy, and court opinions upholding the right of competent persons to refuse medical treatment. Recent case decisions involve decisions to withdraw life-sustaining treatment made by third parties on behalf of those who lack decision-making capacity (Beauchamp and Childress, 1994, pp.
|
From page 20... ...
However, the interests of the organ donation team must not influence the decision to withdraw life sustaining treatment. Due to increasing public awareness of organ donation, families may raise the question of donation before a decision about continuing or withdrawing treatment has been made.
|
From page 21... ...
The 1997 IOM study found that nonheart-beating donation protocols varied in their criteria for declaring death after the cessation of cardiopulmonary function. The report found that some protocols allowed the removal of organs immediately following cardiopulmonary arrest,
|
From page 22... ...
this period of cardiopulmonary arrest be verified by electrocardiographic and arterial pressure monitoring. In the absence of empirical certainty that cardiopulmonary function ceases irreversibly within five minutes of arrest, the IOM report based this recommendation on expert judgment about the terminal physiology of the brain and the circulatory system (IOM, 1 997b, p.
|
From page 24... ...
Because non-heart-beating donation involves those who elect not to continue life sustaining treatment, the 1997 IOM study accepted that death occurs when cardiopulmonary function will not resume spontaneously, and will not be restarted artificially. Critics have suggested that cardiopulmonary function is not irreversibly lost as long as it could conceivably be restored by vigorous resuscitation efforts (Menikoff, 1998~.
|
From page 25... ...
In arriving at these recommendations, the committee considered the work that has been done to set the standards for determining death by neurological criteria. The definition of the irreversible cessation of all brain function and its acceptance as a standard for determining death have been developed through extensive study and debate in medicine, ethics and law (Ad Hoc Committee of the Harvard Medical School, 1968~.
|
From page 26... ...
3. The issue at stake in the determination of death is one of trust that the health care system will provide optimum end-of-life care regardless of the demands of organ procurement.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.