Skip to main content
PMC home page
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 2003 Jun;29(3):182–185. doi: 10.1136/jme.29.3.182

Defining death in non-heart beating organ donors

N Zamperetti 1, R Bellomo 1, C Ronco 1
PMCID: PMC1733717  PMID: 12796442

Abstract

Protocols for retrieving vital organs in consenting patients in cardiovascular arrest (non-heart beating donors, NHBD) rest on the assumptions that irreversible asystole a) identifies the instant of biological death, and b) is clinically assessable at the time when retrieval of vital organs is possible. Unfortunately both assumptions are flawed. We argue that traditional life/death definitions could be actually inadequate to represent the reality of dying under intensive support, and we suggest redefining NHBD protocols on moral, social, and antrhopological criteria, admitting that irreversible (however defined) asystole can only equate a clinically determinable point of no return in the process of dying, where organ retrieval can be morally and socially accepted in previously consenting patients.

Full Text

The Full Text of this article is available as a PDF (106.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnold R. M., Youngner S. J. Back to the future: obtaining organs from non-heart-beating cadavers. Kennedy Inst Ethics J. 1993 Jun;3(2):103–111. doi: 10.1353/ken.0.0120. [DOI] [PubMed] [Google Scholar]
  2. Arnold R. M., Youngner S. J. The dead donor rule: should we stretch it, bend it, or abandon it? Kennedy Inst Ethics J. 1993 Jun;3(2):263–278. doi: 10.1353/ken.0.0153. [DOI] [PubMed] [Google Scholar]
  3. Beecher H. K., Dorr H. I. The new definition of death. Some opposing views. Int Z Klin Pharmakol Ther Toxikol. 1971 Oct;5(2):120–124. [PubMed] [Google Scholar]
  4. Bray J. G., Jr The Lazarus phenomenon revisited. Anesthesiology. 1993 May;78(5):991–991. doi: 10.1097/00000542-199305000-00030. [DOI] [PubMed] [Google Scholar]
  5. Browne A. Whole-brain death reconsidered. J Med Ethics. 1983 Mar;9(1):28-31, 44. doi: 10.1136/jme.9.1.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Broyde M. J. The diagnosis of brain death. N Engl J Med. 2001 Aug 23;345(8):617–618. [PubMed] [Google Scholar]
  7. Cole D. Statutory definitions of death and the management of terminally ill patients who may become organ donors after death. Kennedy Inst Ethics J. 1993 Jun;3(2):145–155. doi: 10.1353/ken.0.0025. [DOI] [PubMed] [Google Scholar]
  8. Cranford R. E., Smith D. R. Consciousness: the most critical moral (constitutional) standard for human personhood. Am J Law Med. 1987;13(2-3):233–248. [PubMed] [Google Scholar]
  9. DeVita M. A., Snyder J. V., Grenvik A. History of organ donation by patients with cardiac death. Kennedy Inst Ethics J. 1993 Jun;3(2):113–129. doi: 10.1353/ken.0.0147. [DOI] [PubMed] [Google Scholar]
  10. DuBois James. Non-heart-beating organ donation: a defense of the required determination of death. J Law Med Ethics. 1999 Summer;27(2):126–136. doi: 10.1111/j.1748-720x.1999.tb01445.x. [DOI] [PubMed] [Google Scholar]
  11. Emanuel L. L. Reexamining death. The asymptotic model and a bounded zone definition. Hastings Cent Rep. 1995 Jul-Aug;25(4):27–35. [PubMed] [Google Scholar]
  12. Fox R. C. "An ignoble form of cannibalism": reflections on the Pittsburgh protocol for procuring organs from non-heart-beating cadavers. Kennedy Inst Ethics J. 1993 Jun;3(2):231–239. doi: 10.1353/ken.0.0070. [DOI] [PubMed] [Google Scholar]
  13. Giacomini M. A change of heart and a change of mind? Technology and the redefinition of death in 1968. Soc Sci Med. 1997 May;44(10):1465–1482. doi: 10.1016/s0277-9536(96)00266-3. [DOI] [PubMed] [Google Scholar]
  14. Herdman Roger, Beauchamp Tom L., Potts John T. The Institute of Medicine's report on non-heart-beating organ transplantation. Kennedy Inst Ethics J. 1998 Mar;8(1):83–90. doi: 10.1353/ken.1998.0003. [DOI] [PubMed] [Google Scholar]
  15. Koblin D. D. Prolonged asystolic hyperkalemic cardiac arrest with no neurologic sequelae: the lazarus phenomenon arises again. Ann Emerg Med. 1995 Apr;25(4):562–563. doi: 10.1016/s0196-0644(95)70279-2. [DOI] [PubMed] [Google Scholar]
  16. Kootstra G. The asystolic, or non-heartbeating, donor. Transplantation. 1997 Apr 15;63(7):917–921. doi: 10.1097/00007890-199704150-00001. [DOI] [PubMed] [Google Scholar]
  17. Lynn J. Are the patients who become organ donors under the Pittsburgh protocol for "non-heart-beating donors" really dead? Kennedy Inst Ethics J. 1993 Jun;3(2):167–178. doi: 10.1353/ken.0.0081. [DOI] [PubMed] [Google Scholar]
  18. Maeda Hitoshi, Fujita Masaki Q., Zhu Bao-Li, Yukioka Hidekazu, Shindo Mitsuo, Quan Li, Ishida Kaori. Death following spontaneous recovery from cardiopulmonary arrest in a hospital mortuary: 'Lazarus phenomenon' in a case of alleged medical negligence. Forensic Sci Int. 2002 Jun 25;127(1-2):82–87. doi: 10.1016/s0379-0738(02)00107-x. [DOI] [PubMed] [Google Scholar]
  19. Maleck W. H., Piper S. N., Triem J., Boldt J., Zittel F. U. Unexpected return of spontaneous circulation after cessation of resuscitation (Lazarus phenomenon) Resuscitation. 1998 Oct-Nov;39(1-2):125–128. doi: 10.1016/s0300-9572(98)00119-1. [DOI] [PubMed] [Google Scholar]
  20. Martens P., Vandekerckhove Y., Mullie A. Restoration of spontaneous circulation after cessation of cardiopulmonary resuscitation. Lancet. 1993 Mar 27;341(8848):841–841. doi: 10.1016/0140-6736(93)90627-s. [DOI] [PubMed] [Google Scholar]
  21. Menikoff Jerry. Doubts about death: the silence of the Institute of Medicine. J Law Med Ethics. 1998 Summer;26(2):157–165. doi: 10.1111/j.1748-720x.1998.tb01671.x. [DOI] [PubMed] [Google Scholar]
  22. Quick G., Bastani B. Prolonged asystolic hyperkalemic cardiac arrest with no neurologic sequelae. Ann Emerg Med. 1994 Aug;24(2):305–311. doi: 10.1016/s0196-0644(94)70144-x. [DOI] [PubMed] [Google Scholar]
  23. Shewmon A. D. The brain and somatic integration: insights into the standard biological rationale for equating "brain death" with death. J Med Philos. 2001 Oct;26(5):457–478. doi: 10.1076/jmep.26.5.457.3000. [DOI] [PubMed] [Google Scholar]
  24. Shewmon D. A. Chronic "brain death": meta-analysis and conceptual consequences. Neurology. 1998 Dec;51(6):1538–1545. doi: 10.1212/wnl.51.6.1538. [DOI] [PubMed] [Google Scholar]
  25. Shewmon D. Alan. Recovery from "brain death": a neurologist's apologia. Linacre Q. 1997 Feb;64(1):30–96. doi: 10.1080/20508549.1999.11878373. [DOI] [PubMed] [Google Scholar]
  26. Tomlinson T. The irreversibility of death: reply to Cole. Kennedy Inst Ethics J. 1993 Jun;3(2):157–165. doi: 10.1353/ken.0.0053. [DOI] [PubMed] [Google Scholar]
  27. Truog R. D., Fackler J. C. Rethinking brain death. Crit Care Med. 1992 Dec;20(12):1705–1713. doi: 10.1097/00003246-199212000-00018. [DOI] [PubMed] [Google Scholar]
  28. Truog R. D. Is it time to abandon brain death? Hastings Cent Rep. 1997 Jan-Feb;27(1):29–37. [PubMed] [Google Scholar]
  29. Veatch R. M. The impending collapse of the whole-brain definition of death. Hastings Cent Rep. 1993 Jul-Aug;23(4):18–24. [PubMed] [Google Scholar]
  30. Weisbard A. J. A polemic on principles: reflections on the Pittsburgh protocol. Kennedy Inst Ethics J. 1993 Jun;3(2):217–230. doi: 10.1353/ken.0.0042. [DOI] [PubMed] [Google Scholar]
  31. Youngner S. J., Arnold R. M., DeVita M. A. When is "dead"? Hastings Cent Rep. 1999 Nov-Dec;29(6):14–21. [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES