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Organ Donation after Cardiac Death

Organ Donation after Cardiac Death - T he N EW ENGLA ND...

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Perspective The NEW ENGLAND JOURNAL of MEDICINE july 19, 2007 n engl j med 357;3 www.nejm.org july 19 , 2007 209 the supply. In 2006, there were about 29,000 solid-organ trans- plantations; as of June 2007, there were about 97,000 people on wait- ing lists for organ transplantation. About three of every four or- gans that are transplanted are recovered from deceased donors. The most rapid increase in the rate of organ recovery from de- ceased persons has occurred in the category of donation after “cardiac death” — that is, a death declared on the basis of cardiopulmonary criteria (irre- versible cessation of circulatory and respiratory function) rather than the neurologic criteria used to declare “brain death” (irrevers- ible loss of all functions of the entire brain, including the brain stem). Organs were recovered from 645 donors after cardiac death in 2006, as compared with 189 in 2002; these donors accounted for 8% of all deceased donors in 2006 (see bar graph). At the Organ Pro- curement Organization at the Uni- versity of Wisconsin, the New En- gland Organ Bank in the Boston area, and the Finger Lakes Donor Recovery Network in New York, such donors accounted for more than 20% of all deceased donors. Since 1968, when an ad hoc committee at Harvard Medical School proposed a brain-based definition of death that became widely accepted, organs for trans- plantation have been removed pri- marily from hospitalized patients who have been pronounced dead on the basis of neurologic crite- ria, when they are on ventilators and their hearts continue to func- tion. The continued circulation of blood helps to prevent the organs from deteriorating. Obtaining organs from donors after cardiac death — when the heart is no longer beating — is the approach that was generally followed in the 1960s and earlier. Today, such donations typically in- volve patients who are on a ven- tilator as the result of devastat- ing and irreversible brain injuries, such as those caused by trauma or intracranial bleeding. Poten- tial donors might also have high spinal cord injuries or end-stage musculoskeletal disease. Although such patients may be so near Organ Donation after Cardiac Death Robert Steinbrook, M.D. A lthough the numbers of organ donors and transplantations in the United States have more than doubled over the past 20 years (see line graph), the demand for organs continues to dwarf The New England Journal of Medicine Downloaded from nejm.org at SUNY STONY BROOK on August 10, 2011. For personal use only. No other uses without permission. Copyright © 2007 Massachusetts Medical Society. All rights reserved.
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PERSPECTIVE n engl j med 357;3 www.nejm.org july 19 , 2007 210 death that further treatment is futile, they are not dead. The United Network for Or- gan Sharing, a private nonprofit group based in Richmond, Vir- ginia, operates the Organ Pro- curement and Transplantation Network under contract with the federal government and is com- mitted to increasing the number of donors. OPTN/UNOS, as the networks are collectively known, has developed rules for donation after cardiac death. According to
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