| Scientific, legal, and ethical challenges of end-of-life organ procurement in emergency medicine. | |
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MedLine Citation:
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PMID: 20678461 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: We review (1) scientific evidence questioning the validity of declaring death and procuring organs in heart-beating (i.e., neurological standard of death) and non-heart-beating (i.e., circulatory-respiratory standard of death) donation; (2) consequences of collaborative programs realigning hospital policies to maximize access of procurement coordinators to critically and terminally ill patients as potential donors on arrival in emergency departments; and (3) ethical and legal ramifications of current practices of organ procurement on patients and their families. DATA SOURCES: Relevant publications in peer-reviewed journals and government websites. RESULTS: Scientific evidence undermines the biological criteria of death that underpin the definition of death in heart-beating (i.e., neurological standard) and non-heart-beating (i.e., circulatory-respiratory standard) donation. Philosophical reinterpretation of the neurological and circulatory-respiratory standards in the death statute, to avoid the appearance of organ procurement as an active life-ending intervention, lacks public and medical consensus. Collaborative programs bundle procurement coordinators together with hospital staff for a team-huddle and implement a quality improvement tool for a Rapid Assessment of Hospital Procurement Barriers in Donation. Procurement coordinators have access to critically ill patients during the course of medical treatment with no donation consent and with family or surrogates unaware of their roles. How these programs affect the medical care of these patients has not been studied. CONCLUSIONS: Policies enforcing end-of-life organ procurement can have unintended consequences: (1) erosion of care in the patient's best interests, (2) lack of transparency, and (3) ethical and legal ramifications of flawed standards of declaring death. |
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Authors:
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Mohamed Y Rady; Joseph L Verheijde; Joan L McGregor |
Publication Detail:
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Type: Journal Article; Review Date: 2010-06-17 |
Journal Detail:
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Title: Resuscitation Volume: 81 ISSN: 1873-1570 ISO Abbreviation: Resuscitation Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-24 Completed Date: 2010-12-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0332173 Medline TA: Resuscitation Country: Ireland |
Other Details:
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Languages: eng Pagination: 1069-78 Citation Subset: IM |
Copyright Information:
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Copyright 2010 Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ 85054, USA. Rady.Mohamed@mayo.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Brain Death Critical Illness* Death Emergency Medicine / ethics*, methods* Ethics, Professional Humans Informed Consent Quality of Health Care Science* Terminology as Topic Tissue and Organ Procurement / ethics*, legislation & jurisprudence* |
| Comments/Corrections | |
Comment In:
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Resuscitation. 2010 Sep;81(9):1061-2
[PMID:
20650558
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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