President

cardiac arrests, due to causes that are internal (e.g. arrhythmia) or external
(e.g. incident, mortal trauma) to the organism, whilst it is subject to different
medical and ethical assessments when it is an event due to serious illnesses,
in advanced state and terminal 249 .
Although a 10 minute period of absolute lack of cardiac activity –
ascertained with certainty – is to be considered an element of high likelihood of
the death of the human being, caution forces us to avoid reducing below 20
minutes the temporal limit of the wait before starting, on the body of the dead
patient, the “technical” procedures that will allow the subsequent removal of
organs. It follows that in Italy – should this practice develop – the eventual
protocols used in the various hospitals for the purpose of removing organs from
a non-heart-beating patient are not and must not be due to isolated or
autonomous decisions, but must be elaborated following the law and its
foundation, approved by the national guarantor authority (National Transplant
Centre) 250 . The centres that will eventually be authorised, will also need to be
made up of particularly qualified personnel, trained in the specific needs of
these cardiological damages, and a public support network for those individuals
suffering from cardiac arrest will have to be guaranteed, endowed with high
efficiency and fast intervention times, with the aim of ensuring first of all a better
chance of resuscitation.
The NBC believes that it is also indispensable to consider the international
scientific debate and to increase the observational studies to verify the scientific
possibility to anticipate the certain and irreversible identification of cardiac
death or the eventual possibility of a temporal limit susceptible to variation case
by case, also taken into account the difference between the diagnosis of
cardiac death in adults and children. The Committee recommends that in
determining this, there should be no place for economical or pragmatic
reasons.
At the basis of this issue is also the question of whether it is ethically
legitimate to interrupt resuscitation procedures that don’t cause suffering, but
“stabilise” the individual’s vital signs (although precarious). For some, the
problem turns into that of therapeutic persistence, for others medical assistance
is intended as an act due to the individual who still shows vital signs. In
addition, at least in the experience already documented on various occasions in
the USA, it is not the individual’s expression of will to “not be resuscitated” or to
interrupt resuscitation treatments objectively considered unproductive (situation
of therapeutic futility), but the assessment of the relatives and/or the legal
representative, which is considered important. The situation is therefore often
extremely complex from an ethical point of view.
Within these protocols, even before ascertaining death with cardiocirculatory
criteria (flat line ECG for 20 minutes) and only after an evident lack
of reaction to cardio-respiratory resuscitation attempts, the NBC believes that
some technical actions that do not damage the patient are legitimate, if they are
aimed at “achieving control for donation purposes after cardiac death” and as
249 In the cases included in the first hypothesis, assistence must be as quick as possible,
because after a few minutes from the cardiac arrest (asystole) the damage – particularly brain
damage – is serious and frequently fatal. The faster the transport and the care of hospital
experts (A&E and intensive therapy centres), with the application of all the adequate criteria of
cardiopulmonary resuscitation (mechanical and pharmacological instruments), the higher the
chance of survival.
250 As the already mentioned Alba Protocol currently does.
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