Manual Op.89 No. 7 - Organ

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Since the benefit of organ donation is for other individuals, it would not usually be acceptable to inflict a significant harm on the patient in order to facilitate organ retrieval. Minor harms may be acceptable, if the donor has consented to them. Where there are alternative courses of action that involve less harm to organ donors, other things being equal, those should be taken in preference. If killing the patient were felt to be a harm, then this principle would also justify and overlap with Principle 7 see below.

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However, since we are discussing patients for whom it is permissible to withdraw life-support, we assume that death is not necessarily a harm for them. The autonomy of individuals is valued extremely highly. We generally think it important to respect the wishes of patients who wish to donate their organs, as well as the wishes of those who do not wish to donate.

Individuals may have made their wishes explicit before becoming ill — for example by signing up to organ donor registries. Some transplant policies may prevent patients from donating their organs who would like to or would have wanted to donate. Other policies may lead to organs being removed when the patient would not have wanted this to occur.

Both represent breaches of autonomy. A related concern is the Kantian rule that prohibits using people merely as a means to an end. But where people wish for their organs to be donated, transplantation respects their autonomous will, and hence does not use them as a mere means. Indeed, by respecting their autonomous wishes it treats them as an end in themselves. Ultimately most decisions to donate organs are taken at a time when patients themselves are not able to express their wishes.

If the patient is not competent, and they have not made relevant advance directives, the patient's family makes decisions about organ donation, reflecting both their beliefs about what the patient would have wanted Principle 3 , as well as the family's own preferences for the terminal care of their loved one.

The wishes of the family may conflict with the wishes of the patient, for example when a family objects to organ donation despite the patient carrying an organ donor card. The family's wishes are usually respected in such cases, though it is far from clear that this is either ethically or legally justified. As defined by some, the dead donor rule explicitly refers to a prohibition on the killing of patients to obtain their organs.

With the exception of donation of non-essential organs from a living patient, it is not thought to be permissible to remove organs from a patient prior to their being declared dead. This may be justified in terms of harms to the patient Principle 2 — the procedure has no benefit to the patient himself or herself, so it may breach the principle of non-maleficence. It may also be justified in terms of the injunction not to kill patients Principle 7 , since the removal of essential organs is likely to lead to death.

Nevertheless there are some conceivable situations where removal of a vital organ would neither harm the patient, nor would it hasten death see option 5 below. So we have retained this as a separate principle here. Organ donation usually occurs after brain death. This might be because it is actually brain death that provides the crucial normative justification for Principle 5. There is a strong deontological proscription against the killing of patients.

Although there are a few jurisdictions where euthanasia is permitted, most societies hold that doctors should not kill their patients. On the other hand it is almost universally accepted that doctors may withdraw or withhold LST in patients who are dying or who have a very poor prognosis. This is not usually classified as an act of killing on the basis of the doctrine of double effect and the difference between acts and omissions.

What alternatives are there to existing policies and procedures for organ donation from LSW donors? How would they affect organ quality and supply, and how would they cohere or conflict with the Fundamental Principles of transplantation? There are two main possibilities. Changes to the processes for obtaining consent would increase the number of organ donors without changing any of the procedures for obtaining organs. Alternatively there a number of possible changes to organ retrieval that would affect the number and viability of organs retrieved.

Box 4 , Table 1 Combinations of these are conceivable. As an illustration of the possible effects of these alternatives, we will draw on data from the UK Potential Donor Audit Table 2. Nevertheless they may be useful to put into context the possible benefits of different policies. Estimated potential changes to organ supply in the UK with different options, per year. See Appendix for an explanation of how these figures were derived. Footnotes in the Table refer to the Appendix.

Option 2 — Organ Donation Euthanasia : Removal of organs from patient under general anaesthesia. Death would follow removal of heart. Option 3 — Cardiac euthanasia followed by organ donation : Euthanasia by administration of anaesthetic and cardioplegic agents. Removal of organs after cessation of circulation. Option 4 — Neuro-euthanasia followed by organ donation : Euthanasia by occlusion of blood vessels to the brain.

Removal of organs after brain death certified. Option 5 — Organ donation prior to natural death : Removal of non-vital organs prior to withdrawal of LST. Option 7 — Reduction in asystolic period prior to certification of cardiac death. The most dramatic way to increase the conversion rate the proportion of potential donors who end up donating would be a form of organ conscription. Thus it has the potential to increase the number of organs for transplantation in the UK by up to per year.

It would violate the principles of Patient and Family Autonomy Principles 3 and 4 , and could be criticized for using patients as a mere means. Smaller increments in organ donation could be achieved in the UK by moving to an opt-out consent system for organ donation. Some have concerns about whether this would violate the wishes of patients.

Most countries that have adopted a form of opt-out consent including Spain, with the highest donation rates per capita permit family members to veto organ donation, even where the patient has not opted out during life. A change to an opt-out consent system in the UK would potentially increase the number of transplantable organs by per year. In a small number of cases families decline organ donation even though the patient had indicated during life that they would like to donate by joining the organ donor register.

If families were unable to veto organ donation in such cases this would potentially make available 67 additional organs per year in the UK Table 2. Alternatively, there may be ways to improve the efficiency of organ donation without changing the nature of consent decisions.

This would not violate any of the listed ethical principles governing organ transplantation, but would require significant resources to be made available for counselling and support. This would potentially be sufficient to resolve the current shortfall in organ supply. It is permissible to withdraw life support from a patient with extremely poor prognosis, in the knowledge that this will certainly lead to their death, even if it would be possible to keep them alive for some time.

It is permissible to remove their organs after they have died. But why should surgeons have to wait until the patient has died as a result of withdrawal of advanced life support or even simple life prolonging medical treatment? An alternative would be to anaesthetize the patient and remove organs, including the heart and lungs. The process of death would be less likely to be associated with suffering for the patient than death following withdrawal of LST which is not usually accompanied by full anaesthetic doses of drugs.

If there were a careful and appropriate process for selection, no patient would die who would not otherwise have died. More organs would be available for example the heart and lungs, which are currently rarely available in the setting of DCD. Patients and families could be reassured that their organs would be able to help other individuals as long as there were recipients available, and there were no contraindications to transplantation. This is not the case at present with DCD, since many patients do not die sufficiently quickly following withdrawal of LST for organ retrieval.

This proposal has been mooted before. ODE would not be likely to cause the patient suffering, however, it would conflict with Principles 5, 6 the dead donor rules and 7 non-killing. Technically, this would be a form of killing — active euthanasia. It would conflict with the doctrine of double effect. Yet the justification for ODE is wider than that for organ donation from permanently unconscious or brain dead patients. The broader justification for ODE includes not merely those who no longer have interests, but those who will inevitably shortly die. The argument for removing organs from this group is even stronger.

It does not rely on controversial judgements of quality of life, wellbeing or interests. These patients will die because they are on life sustaining treatment and it will be withdrawn. Indeed we would suggest that, although most arguments for euthanasia are distinguished from questions of organ donation, it may be that the benefits of donation, for the individual and for others, provide the strongest case for euthanasia.

One of the most basic principles of rationality and economics is that if one state of affairs is a Pareto improvement , we have strong reason to prefer it. Similarly, changes that involve benefits in some respects, but costs in other respects would not be Pareto superior. ODE for LSW donors can be regarded as a Pareto improvement to the current practice of withdrawal of life-sustaining treatment and donation after cardiac death. In all cases the patient dies, but in the case of ODE more lives are able to be saved by harvesting functioning organs, and the desire of the patient that their organs be used to help others is more likely to be able to be respected.

ODE might not be regarded as a Pareto improvement if the killing of the patient were regarded as a moral harm or a rights violation. Note that while ODE in the case of withdrawal of LSW donors is a Pareto improvement, the same might not be said for removing organs from patients who are permanently unconscious, unless treatment would otherwise be withdrawn.

Such patients may survive for some time, and have a finite albeit small chance of spontaneous or treatment-induced improvement in consciousness. It is difficult to estimate the effect of introducing ODE on overall organ donation rates. It could be up to an additional organs per year in the UK: crucially, however, it would depend upon the consent rates for organ donation and how they are affected by the introduction of this alternative.

See Section F for further discussion of this Nevertheless it would provide individuals with the greatest possible chance of donating their organs to others. For each patient who would not otherwise be able to donate because death would be too prolonged following withdrawal of LST , up to nine additional individuals would be able to receive organs. If we believe that we should not remove organs from patients who are still alive, even where they have consented to this and would otherwise die anyway, then one alternative would be to euthanize the donor and retrieve organs after cardiac death had been declared.

This would already be a theoretical option in countries where euthanasia is permitted. Organ donation after cardiac euthanasia has been described in a patient in Belgium. Again, this would reduce the risk of patients suffering after withdrawal of LST and make organ donation possible for some patients who would otherwise not be able to donate. In an extreme case, they might choose to undergo euthanasia at least partly to ensure that their organs could be donated.

However, the agent used to stop the heart, and the period of loss of circulation that ensued, might compromise organ viability in the same way as DCD does at present. The magnitude of the benefit is hard to quantify but it is likely to be less than ODE. Since patients who donate organs after Cardiac Euthanasia Option 3 may be able to donate fewer organs and have more compromised organs than HB donors, one option would to perform euthanasia in such a way as to induce brain death we could call this Neuro-euthanasia.

After sedation and local anaesthesia, catheters could be inserted into blood vessels in the groin of the patient. These could then be advanced to the blood vessels supplying the brain. Catheter occlusion of both internal carotid arteries and vertebral arteries would lead to brain death, while life support would continue to be provided to maintain the circulation to other organs. After brain death was confirmed, organs could be retrieved. There may be concerns about possible discomfort to the patient caused by the neuro-euthanasia procedure; but this could be mitigated by giving the patient a general anaesthetic before the procedure.

But Neuro-euthanasia may affect the viability of organs for transplantation. There are variable criteria for diagnosing brain death across the world.


Maintenance of circulation and organ viability is not always easy after brain death, and the process of brain death itself may compromise subsequent organ function. Obviously both Options 3 and 4 would violate the injunction against physician killing Principle 7 even if they do not violate the dead donor rules Principles 5 and 6.

It is hard to believe, however, that if it is permissible to euthanize a patient who would otherwise die following withdrawal of life support, that Neuro-euthanasia prior to organ donation would be preferable to ODE. Are there options that do not involve physician killing? It is permissible for living patients to donate non-essential organs.

For patients who are dying, or who will die rapidly of cardio-respiratory failure following withdrawal of LST, certain organs are no longer essential. Patients could be anaesthetized and solid organs removed, for example kidney, liver, and pancreas. Removal of these organs would probably not hasten death.

Other organs may be able to be retrieved after cardiac death was established. This option would conflict with Principles 5 and 6, the dead donor rules. But since it is permissible to donate non-essential organs for example in living related or altruistic kidney donation these rules do not necessarily preclude donation. If organ donation occurs under anaesthesia it would be unlikely to cause the patient to suffer immediately. However, since patients are sedated but not usually fully anaesthetized at the time when LST is withdrawn, it is possible that after the surgery but prior to death the donor would experience pain that they would not otherwise have experienced.

Such patients could experience negative consequences of having organs removed, and their death may be hastened.

Schubert, Franz Peter

Pancreas and kidney function could be provided artificially, however, liver function is not able to be readily replaced. The numbers of additional organs that would be available from this policy are likely to be significantly less than with Options 2—4. Table 2. Heart-lung bypass ECMO has already been used after death to improve the perfusion of organs until they can be retrieved.

The bypass machine would support the circulation of all organs except the heart, lungs and brain. Life support except the ECMO machine would be withdrawn, and the patient's heart allowed to stop naturally. Once the patient was declared dead, the organs could be removed. The advantage of this procedure would be that organs could be retrieved even if it took some hours for the patient's heart to stop. There would be no unseemly rush after life support was removed, and family could spend time with the patient after death, before organ removal.

Non-brain ECMO would not change the status of the patient, since cardiac death would lead to brain death. Non-brain ECMO would not cause the patient's death so it would not necessarily violate Principles 5—7. It should be noted that although non-brain ECMO would be technically possible, it would be difficult to be sure that it would not alter the progression to cardiac death after withdrawal of LST.

ECMO is an expensive and invasive intervention, and could potentially harm the patient Principle 2. It would potentially lead to similar numbers of organs to Option 3 Cardiac euthanasia prior to organ donation. Thoracic organs would not be able to be retrieved. Currently most DCD organ donation procedures commence 5—10 minutes after the heart has stopped asystole. Some centres commence organ donation earlier, after 2 79 or even 1. However, this interval could be shortened further, for example to 20 seconds before declaration of death. Current definitions of cardiac death are based upon the idea of irreversible cessation of circulation.

Although the circulation could be restarted with initiation of resuscitation measures after periods of even 10 minutes of asystole, it has been argued that in the context of withdrawal of LST it would not be appropriate or ethical to attempt to do so. But the heart may sometimes start again by itself so-called autoresuscitation after brief periods of asystole. So this option may hasten death in patients where the heart would have autoresuscitated had not organ retrieval commenced thus contravening Principle 7.

Option 7 would not lead to any more donors than available at present, though it would increase the viability of organs from DCD donors, and potentially make donation of heart and lungs from such patients possible. The aforementioned alternatives for increasing organ availability may seem disturbing or even shocking. As highlighted, they conflict to some degree with one or more of the fundamental principles governing organ transplantation and the care of dying patients.

The needs of patients who are suffering and dying for want of available organs have previously led us to revise our principles governing transplantation. Perhaps they should again. What specific objections might be raised to them? One objection to most of the above alternative organ donation procedures is that the prior consent of donors may not apply.

Felix Alexandre Guilmant - Organ Works (Naxos Audio CD)

It is not likely, for example, that current potential donors had imagined that they might be placed on heart bypass machines before their death in order to maintain their organs. A similar criticism has been levelled at DCD as currently practised, 86 and may have applied in the case of Ruben Navarro, referred to at the start of this paper. It might not apply to all patients however, and this criticism would not necessarily apply to future donors. If a society adopted Option 2 for example, it may then come to be widely understood that those who consent to organ donation and who are dying in intensive care would have their organs removed in a surgical procedure that would lead to death.

The important question for Options 2 to 7 is whether such procedures should be allowed — if consent is given. Furthermore it would be possible to give donors a range of options of organ donation, and the freedom to choose the method that is most consistent with their own values. This would fully respect the autonomy of donors and may increase the acceptability of changes to organ donation practice see below. One of the alternatives outlined above is to reject the need for consent for organ donation and to conscript organs Option 1a.

This would require a paradigm shift in approach to organ donation, but as is apparent from Table 2 , it is the alternative likely to lead to the greatest increase in the number of available organs. The main reason not to have an organ draft would be that it would violate the autonomy of patients and families who do not wish to donate. We need to weigh this against the substantial burden of death and illness that organ conscription could prevent. At times of great community need for example during war conscription of the living for military service has been the norm, and continues to be in some parts of the world.

Organ Conscription would seem a far preferable alternative to military conscription since it would involve no individuals dying or suffering for the sake of others. But the greatest hurdle to any such change may be community acceptance. There is significant public concern about elements of current transplantation practice. So it may be argued that any of the alternatives discussed in this paper particularly the more radical ones would be extremely unlikely to meet with general community acceptance and hence would not be politically achievable. A related concern is that this may threaten acceptance of transplantation more generally.

In the absence of conscription, organ donation is dependent upon the implicit or explicit consent of potential donors. Organ donation options outlined above may alienate or disenchant potential donors. They could paradoxically lead to an overall reduction in available organs due to fewer people signing on to organ donor registries, and fewer families consenting for donation. If it were the case that changes to organ donation procedures led to a fall in consent rates, this would undermine the principal reason that we have given to change donation procedures.

However, whether or not this eventuates would depend upon how such a change were instituted, how the consent of patients were sought, and how well public concerns about such a change were able to be allayed. It is not necessarily the case that changes to organ donation would lead to a loss of community confidence. For example, one option mentioned in the preceding section would be to allow patients specifically to opt in to the novel procedure or to a range of novel procedures of their choice.

This sort of specific consent would maximize patient autonomy in relation to organ donation, as well as to helping to allay community fears. It should be noted though, that this may reduce the effectiveness of the change in terms of increasing the numbers of available organs. It is likely that at least initially the numbers of individuals who would opt-in to ODE for example would be small. It would mean that the overall impact of introducing ODE would be much less than the estimates in Table 2. It would undermine the case in terms of organ supply for this alternative.

It could, however, be used as proof in principle of the procedure as a way of ethically increasing the supply of organs. Two other important community fears that would need to be addressed in any change in organ donation policy include patient selection for donation, and harm associated with the procedures.

One concern sometimes expressed about changes to organ donation procedures is that this may lead to the death of patients who would have otherwise survived. If doctors know that a patient's organs can be used to save others' lives, it may influence their assessment of whether a patient's condition is truly hopeless. Of course, this concern might apply equally to current practice of DCD as for Options 5 to 7.

It could be thought to apply in the case of Ruben Navarro, for example. It would potentially be a greater concern for Options 2—4, since they would involve actions leading to the patient's death. Yet it is possible to prevent this from happening. Current practice for diagnosis of brain death, or for decisions about withdrawal of LST, is that these processes are temporally and logistically separated from considerations of eligibility and consent for transplantation.

The question of whether or not a patient would have wanted to donate her organs, and whether the family would agree to this, is only raised after a decision has already been made to withdraw life support. People not involved in the clinical care of the patient for example regional transplant coordinators usually initiate such discussions.

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And intensive care staff rather than the transplant team provide the care of the patient after withdrawal of LST. It may be a greater concern if organs are conscripted, since doctors will know with certainty that if brain death is diagnosed, or if a decision is made to withdraw LST, organs will be available to be retrieved.

One additional measure that could prevent abuse and allay concern would be to set up an independent body responsible for confirming brain death or extremely poor prognosis. This group's sole function would be to perform neurological tests and to review prognostic information. They would be called in, as regional transplant teams are currently called in, when a patient was felt by doctors to be a potential organ donor.

But they would have no role in transplants, and would be responsible for ensuring that patients with a significant chance of meaningful recovery were not euthanized or allowed to die. If there were careful selection, including independent scrutiny of decisions, changes to transplantation processes would not necessarily lead to any patients dying who would otherwise have lived.

Indeed, such a process may promote more ethical withdrawal of treatment. The other fear related to organ donation that would need to be addressed if the community were going to embrace a change in practice, is that of harm or suffering from organ donation. It is one thing for someone to agree to donate their organs after death. At that point, they cannot be harmed by what happens to their body. However, if transplantation practice is changed to include procedures that can take place before death, patients may have some reason to worry about whether they will suffer as a consequence.

One fear that people sometimes express about organ donation is of being conscious of having one's organs removed. If Option 2 Organ Donation Euthanasia were adopted, then people might have more reason than at present to harbour this fear. However organ donation would occur under general anaesthesia. There would be no more reason to fear being conscious during this procedure than there is to fear being conscious during any surgical procedure, including the widely accepted practice of live kidney donation.

In fact there is some reason to think that options 2—4 would be less likely to cause patients to suffer than current procedures for withdrawal of life support and organ donation. On the other hand, Options 5 to 7 could be associated with conscious suffering for the organ donor. This would count strongly against them, or would mandate their modification to avoid this possibility.

Some may argue that even if it would be, in theory, possible to gain community acceptance of an alternative such as ODE, other alternatives should be pursued first. For example, improved efficiency of obtaining consent, or the adoption of higher brain criteria for brain death may be politically easier to achieve. However, given the ongoing preventable death of large numbers of patients with organ failure, we believe that it is important to consider seriously all the alternatives. Unless, and until these other options alleviate the demand for organs, there is good reason to permit ODE.

Finally, it may be objected that the arguments advanced above in support of novel organ donation alternatives would support a much broader policy of allowing patients to choose Organ Donation Euthanasia, for example if they were terminally ill or rationally suicidal. However, although Options 2—4 would conflict with the doctrine of double effect and Principle 7 Non-killing , it does not follow from the arguments in this paper that other instances of intentional ending of life would be necessarily permissible.

ODE, as we have described it, is supported by a basic principle of rationality. It would be a Pareto improvement in that only patients who would have died anyway donate their organs. In contrast, the introduction of a policy of voluntary active euthanasia would not be a Pareto improvement, since it would involve the death of patients who would otherwise have lived.

The arguments developed above may lead some to reject the doctrine of double effect, and consider allowing voluntary active euthanasia. But we have suggested that there are particularly strong reasons for allowing individuals to choose how their life ends if they are dependent on life support and life-sustaining treatment is going to be withdrawn. Those who do not wish to support voluntary active euthanasia in other circumstances should consider whether an exception to the doctrine of double effect and the Principle of Non-Killing is justified in this situation.

At the start of this paper we referred to the case of Ruben Navarro. It might be thought that his case highlights the dangers of expanding organ donation processes. Some of the above concerns including in particular those of consent and patient selection were expressed in media commentary on the case.

In this paper we have argued that one of the ethical principles that should influence, and in the past has influenced transplantation policy is the need to maximize the number and quality of organs for transplantation. There is a substantial shortfall in organs for transplant. We could overcome this in a range of ways.

Future developments in xenotransplantation, stem cell-based therapies, or neo-organs might make the use of organs from deceased donors unnecessary. However, such solutions are some time off, and in the meantime thousands of patients per year die for want of a transplanted organ. The most promising immediate source of organs for transplantation is the large number of patients who die in intensive care units in hospitals following diagnosis of brain death, or decisions to withdraw LST on the basis of poor prognosis, the group that we have referred to as LSW donors.

At present the majority of such organs are buried or burned with the patient. We have suggested a set of options for increasing the number of organs that could be made available from LSW donors. Simple measures should be adopted, including improved efficiency of approaching families for consent or a switch to an opt-out consent system; however, they may not be enough to resolve the organ shortfall.

GUILMANT: Organ Works

Organ Conscription would have the greatest potential to increase the numbers of organs available for transplantation, though it would come at the cost of patient and family autonomy. If Organ Conscription is not acceptable, the alternative that would have the greatest potential in terms of organ numbers would be Organ Donation Euthanasia. Box 5. Definition : Removal of organs from a patient under general anaesthesia. Death follows removal of the heart. It would provide patients with the greatest chance of being able to donate their organs after death.

It would be a Pareto improvement over current practice for treatment withdrawal and increase the number and quality of organs available for transplantation. Suffering or discomfort for the patient would be less likely than with withdrawal of life support. Organ Donation Euthanasia would conflict with the dead donor rules, and the injunction against physician killing.

Yet it would not if appropriate safeguards were provided lead to the death of any patients who would otherwise live. The justification for this is not limited to utilitarian considerations. It is a Pareto improvement on current practice for withdrawal of LST and organ donation, and may be Pareto optimal.

Guilmant: 7. Sonate op. 89 - III. Intermezzo

ODE would apply to patients who are going to die — and soon. It is already accepted that it is permissible to withdraw life support from these patients. It would prevent those individuals from suffering as a consequence of withdrawal of life support. And it would save the lives of up to 9 other individuals.

Many potential LSW donors, even if they would have wanted to donate their organs, and their families consent, are currently unable to donate. Their organs die with them. The most acceptable way to introduce Organ-Donation Euthanasia would be to make it available as an option for prospective organ donors. It must be noted, though, that if ODE were made available in this way, it would have at least in the short term only a small impact upon the organ shortfall since only a few individuals would be likely to embrace it.

This would undermine to some degree the case in terms of organ supply for ODE. But if we can save even one life, that is something of great moral importance. Many lives could be saved even if only a small percentage of people opted for ODE. And there is also a strong autonomy-based argument for allowing individuals who wish to donate their organs to opt in to ODE in the circumstance that they are severely ill in intensive care and going to have life support withdrawn.

We should allow people to make advance directives indicating that they would like to be eligible for this alternative. We should encourage and support such altruistic desires. To some degree at least, there is a conflict between the need to supply organs to the largest number of individuals able to benefit from them, and our beliefs about how we ought to care for those who are dying or dead. We have outlined seven alternatives that may increase the supply of organs. These alternatives clash with one or more of the traditionally accepted ethical principles that govern transplantation, though they potentially promote other ethical values including those of autonomy and beneficence.

Whichever transplantation policy is adopted, we should ensure that decisions about withdrawal of life-sustaining treatment are separated from decisions about organ donation, and that organ donation procedures carry minimal risks of causing suffering to organ donors. But continuing current transplantation practice comes at a cost, in terms of a significant number of patients who die or continue to suffer organ failure for want of an available organ.

We should think seriously about whether it is time to embrace an alternative strategy. There are patients on waiting lists for organs from a deceased donor , and approximately patients die on waiting lists per year. We have assumed that HB donors yield 3.

This assumption may not be valid. See Section F. Some alternatives could yield more organs than would be needed to prevent the death of patients on waiting lists. Additional organs would reduce the waiting period for transplantation, and may also make it possible for patients previously excluded from transplantation to be offered organs. It is not clear how many patients fall into this latter category, but the number may be considerable.

Not all patients who currently consent or whose families consent to organ donation end up donating their organs. This might be because their organs are unsuitable for donation for example if they do not die quickly after withdrawal of LST, or if an unsuspected malignancy is found at the time of organ donation. This would potentially translate into a 2.

The maximum benefit for organ donation euthanasia depends upon the number of eligible patients. Current patients who are DCD donors would be able to donate more organs they would become HB donors — this is the reason for the negative net number of DCD donors. There would be additional patients who currently are not eligible to donate by DCD because they do not die soon enough after withdrawal of LST.

Assuming that these patients fall into this category of slower death, euthanasia prior to organ donation would lead to an additional 93 HB equivalent donors. Quantity Discounts with Forwoods ScoreStore! Are you in music education? Delivery Times We aim to dispatch every order within 24 hours excluding weekends. However, we have learned from experience not to make promises regarding delivery.

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