Ethical Issues in the Use of Asystolic Donors
The modern era of allogenic organ transplantation began in the mid 1960s. Then, improvement in surgical techniques, understanding of immunologic tolerance, and the development of drugs to control rejection expanded the technical feasibility of transplantation procedures. To some this represented a "crisis of success" as there was a resultant increase in demand for organs without a parallel increase in supply. According to the United Network for Organ Sharing' database there are now 75,000 patients waiting for an organ. Among those waiting for a heart or liver transplant approximately 1/3 will die before an organ becomes available.2 The primary source of donor organs will be those who have had an irreversible cessation of total brain function and who are being maintained on ventilators in intensive care units. These are commonly called Heart Beating Cadaver Donors and will constitute a pool of 10,000-12,000 potential donors per year. Despite extensive public awareness campaigns, the ratio of actual to potential donors has not increased sufficiently. One response has been to attempt a greater reliance on living donors (kidneys) partial transplants (liver and lungs) and sources of dubious ethical propriety such as anencephalic infants and animals.4 Another potential source of transplantable organs is patients who have been declared dead by traditional cardiopulmonary, rather than brain-based criteria. These are referred to as Non-Heart Beating Cadaver Donors. The success of transplants using organs from these sources has been limited by problems with warm ischemia. Two recent strategies to