Beating heart no barrier for start of transplant work

Clara Pirani, Medical reporter

June 28, 2006

DOCTORS could begin work to remove the organs of brain-dead patients who still had a heartbeat as part of an attempt to improve transplant success rates.

The Australian Health Ethics Committee is considering whether to allow medical procedures to be performed on patients while they are still attached to a ventilator, to prevent deterioration of their organs.

Under the mooted guidelines, if the family consented to organ donation and the patient was declared brain-dead by two doctors, he or she would be removed from intensive care and taken to an operating theatre while still attached to a ventilator.

Blood tests would be performed and a tube would be inserted into the main artery of each leg. The preparation would allow doctors to begin the transplant as soon as the ventilator was removed and the patient stopped breathing.

"Once death has been established, then fluids that would better preserve the body and cool the organs will be inserted into the cannula to reduce deterioration of the organs," said Peter Joseph, chairman of the AHEC's working party on organ donation. "It is thought that this would significantly improve the success of organ donation for some organs.

"It has been done in other countries, certainly in the US. No organ will ever be taken from someone who is not dead."

But Dr Joseph said he was concerned public opposition to the new organ donation guidelines could prevent changes that would significantly improve the success rate of some transplants.

"We are concerned that this may be perceived as some premature intervention," he said. "And we are also concerned that if this is misrepresented to the public, that this has the capacity to significantly impair the organ donation rates in this country.

"The current considerations would only occur if the patient had indicated their wish to be an organ donor and the family had also consented."

According to the proposed guidelines, the option of organ donation would be raised only after the family agreed to discontinue life support.

"To improve the chances of organs being suitable for transplantation, some treatments are needed before the person dies," the draft proposal states.

Bernadette Tobin, director of the Plunkett Centre for Ethics in Sydney, described the guidelines as "ethically admirable".

"It is made very clear that organs and tissues must be retrieved in ways that give precedence to the needs of the potential donor and their family, over the interests of organ procurement," she said.

"I have never seen that stated so clearly and so well in Australia as it is in these guidelines."

Medical director of the lung transplant unit at Sydney's St Vincent's Hospital Allan Glanville said the procedures could improve the success rate of some organ transplants.

"We need to do something in Australia to make sure all the people who are on dialysis, ventilators, cardiac support, while they wait for a transplant, have a chance at a better outcome. I think this is one thing that will help."

The AHEC, which advises the Government on ethical issues, received 73 submissions from medical bodies, ethics groups and the public in response to the proposals. It hopes to finalise the guidelines this year.

Copyright © 2006 The Australian.

This article posted August 13, 2006.