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Archived Comments for: Defining the vital condition for organ donation

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  1. Defining the Vital Conditions for Organ Donation, Uncertainty Remains.

    jan g zijlstra, University Medical Center Groningen, University of Groningen

    12 December 2007

    Olga M. Peters-Polman MD, Jack J Ligtenberg MD PhD, John H. Meertens MD, Jaap E. Tulleken MD PhD, and Jan G. Zijlstra MD PhD BSc

    Bellomo and Zamparetti [1] describe the difficulties in defining death as a condition sine qua non for organ donation. They propose to abandon the clinical definition of either brain or circulatory death as a criterion for donation because of the many uncertainties that surround this definition. As far as we understand they suggest replacing the definition of the moment of death as a point in time by a definition describing death as an irreversible process The duration of this process is considered by them to be a consequence of modern intensive care. The irreversibility of the process is determined by clinical criteria. In our view this is not an essential change in the paradigm. One uncertainty is replaced by another uncertainty. It is not possible to determine irreversibility with absolute certainty, especially in a phase of the process when organ donation would still be possible. Being uncertain is not a real problem for intensivists: we are used to it. As long as we make decisions based on probabilities only in the interest of the patient there is no problem. We balance, with involvement of patients and relatives, the odds for the patient. Of course we would prefer to know in advance, but we are living in a real world and clairvoyance is not one of our skills. Whatever way we choose to define the vital condition of the patient it should always only be in the interest of the patient. The patient should be the only stakeholder. When other interests sneak into the discussion, either financial, shortage of beds or other patients in need of a donor organ, real ethical problems arise. One of the safeguards should be a complete separation of the process of deciding whether a patient is dead or irreversibly dying from the donation procedure. Ideally, doctors caring for potential donors should not take care of potential acceptors or post-transplant patients.

    References

    1. Bellomo R, Zamperetti N. Defining the vital condition for organ donation. Philosophy, Ethics and Humanities in Medicine 2007. http://www.peh-med.com/content/2/1/27

    Competing interests

    Non declared

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