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In ER, new ethics dilemma arises

Test of rapid organ donations raises controversy

By Rob Stein
Washington Post / March 21, 2010

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WASHINGTON — In the hope of expanding a controversial form of organ donation into emergency rooms around the United States, a federally funded project has begun trying to obtain kidneys, livers, and possibly other body parts from car accident victims, heart attack fatalities, and other urgent-care patients.

Using a $321,000 grant from the Department of Health and Human Services, the emergency departments at the University of Pittsburgh Medical CenterPresbyterian Hospital and Allegheny General Hospital in Pittsburgh have started rapidly identifying donors among patients doctors are unable to save and taking steps to preserve their organs so a transplant team can rush to try to retrieve them.

Obtaining organs from emergency room patients has long been considered off-limits in the United States because of ethical and logistical concerns.

This pilot project aims to investigate whether it is feasible and encourage other hospitals nationwide to follow if it is. Neither hospital has gotten any usable organs.

“This is about helping people who have declared themselves to be donors, but die in a place where donation is currently not possible,’’ said Clifton Callaway, an associate professor of emergency medicine at the University of Pittsburgh who is leading the project. “It’s also about helping the large number of people awaiting transplants who could die waiting because of the shortage of organs.’’

Critics say the program represents a troubling attempt to bring a questionable form of organ procurement into an even more ethically dicey situation: the tumultuous environment of an ER, where more than ever it raises the specter of doctors preying on dying patients for their organs.

“There’s a fine line between methods that are pioneering and methods that are predatory,’’ said Leslie Whetstine, a bioethicist at Walsh University in Ohio. “This seems to me to be in the latter category. It’s ghoulish.’’

For decades, most hearts, lungs, kidneys, livers, and other organs obtained for transplants in the United States have come from patients who have been pronounced dead in a hospital after a complete cessation of brain activity, known as brain death, was carefully determined.

But because thousands of people die each year waiting for organ transplants, the federal government has begun promoting an alternative that involves surgeons taking organs, within minutes, from patients whose hearts have stopped beating but who have not been declared brain-dead.

The faster organs are retrieved, the better the chances they will be useable.

Although increasingly common, the practice remains controversial because of questions about whether organ preservation and removal might begin before patients are technically dead, and because of fears that doctors might not do everything possible to save patients and may even hasten their deaths, to increase the chance of obtaining organs.

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