Ethical issues and the role of anesthesiologists in non-heart-beating organ donation

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Abstract
Demand for vital organs for transplantation continues to increase, and the supply of organs has not kept up with demand. The use of organs harvested immediately after death from patients who have requested withdrawal of life support may be one way to increase supply. Anesthesiologists frequently become involved with such ‘non-heart-beating’ organ donations when they are asked to withdraw life support from patients in the operating room and monitor them, providing terminal care, until death ensues. Despite thorough debate in the literature and reviews by the Institute of Medicine, ethical controversies remain concerning the use of non-heart-beating donors. Further, non-heart-beating organ donation has failed to produce the windfall of vital organs for transplant predicted by optimistic early estimates. There is agreement in the medical specialties of palliative care, intensive care medicine, internal medicine, and family practice that competency in end-of-life care requires specialty training. Most anesthesiologists are poorly qualified to carry out the tasks involved in non-heart-beating donation, and may even potentially compromise care. Ethical controversies in the use of non-heart-beating donors remain despite thorough review. No physician should be involved in withdrawal of life support in non-heart-beating donors, unless specialty trained in end-of-life care. Most anesthesiologists should not be involved in non-heart-beating organ donations; potential exceptions include those with specialty training or experienced in palliative care or intensive care medicine.