The Case for Kidney Donation Before End-of-Life Care

Taylor & Francis Online :: The Case for Kidney Donation Before End-of-Life Care - The American Journal of Bioethics - Volume 12, Issue 6: Paul Morrisey argues, "Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor's death, this approach satisfies the dead donor rule. The donor family's wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives."

The tricky question is whether the operation causes death. Morrissey says No. But critics have been scathing: “Bilateral donor nephrectomy will have catastrophic consequences on survivors of erroneous prediction of poor neurologic outcome or survival after [withdrawal of life support]. Morrissey's proposal violates the Hippocratic Oath of do-no-harm and the public trust in professional obligations to serve patients’ best interests.”
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