About non-heart-beating death criterion, doubts are really more clinical than ethical, we believe that until these are resolved, the use of cardiac arrest to obtain organs could be questioned.
On 19th May this year, Europa Press presented a Report by Dr Rafael Matesanz (see HERE), director of the Spanish National Transplant Organization (see also HERE), to the Spanish Health Minister Dolors Montserrat, which included transplant data for the year 2016.
The Report made reference to asystolic – defined as the complete absence of electrical activity in the myocardium – as a death criterion for organ donation, the heart is at a total standstill (non-heart-beating donation), stating that, “it is established as the clearest way to expand the number of transplants, with a total of 494494 donors, representing a 57% increase; it accounts for 24% of all deceased donors, or in other words, 1.4 donors are in asystole”.
In our opinion, however, using asystole as a criterion for potentially obtaining organs raises objective ethical questions, as there are still many critical points to resolve in relation to this issue. These include:
1.- For Maastricht III donors, i.e. those in whom controlled cardiac arrest is performed:
- Is the limitation of therapeutic effort conditioned by the subsequent donation?
- Is the dead donor rule violated (as death occurs at a determined time and place)?
- Is it ethically acceptable to manipulate bodies before death (placement of catheters, etc.)?
2.- For Maastricht II donors, which refers to those others who suffer a cardiac arrest and who due to unsuccessful resuscitation are considered deceased patients:
- Is the patient in cardiac arrest transferred to the best hospital for resuscitation?
3.- And for both types of donors:
- Why in Spain is death diagnosed only 5 minutes after cessation of cardiac activity (in Italy, for example, it is 20 minutes)?
- Does the phenomenon of self-resuscitation exist?
- Why is an aortic balloon inflated in these patients so that the brain and heart are not perfused?
Our ethical assessement of asystole death criterion
We are therefore of the opinion that objective ethical questions still remain before this type of donation can be considered morally acceptable. Although many of these doubts are really more clinical than ethical, we believe that until these are resolved, the use of the criterion of cardiac arrest to obtain organs could be questioned.
Institute of Life Sciences
Catholic Univeristy of Valencia