Summer 2009 - British Columbia Transplant Society

organ donation
kidney donations and transplants in
this country. Creating a centralized
registry such as this gives us critical
mass, greatly increases the chances
of finding suitable matches, and more
living donors will have their wishes
fulfilled. Canadians in need will now
be able to get compatible kidneys
faster, and that will save lives.”
The cross Canada domino transplant
on June 24 th was the first resulting
from the newly formed Living Donor
Paired Exchange Registry in Canada.
As more transplant programs across
the country begin to participate in
the Registry, the donor pool will grow,
allowing for more large scale kidney
exchanges and domino transplants.
How are pairs entered into the
Living Donor Paired Exchange
Registry?
If the blood tests indicate that the
recipient and donor do not match,
they are considered an incompatible
pair. This means that the donor’s
blood type is not compatible
with the recipient’s blood type.
If the ‘incompatible’ donor is still
interested in donating a kidney, the
pair can be tested to see if they are
healthy enough to participate in
an exchange. If they qualify, their
medical information is entered into
the LDPE Registry.
Who can donate a kidney through
the LDPE Registry?
Any person in general good health
can potentially donate a kidney and
be entered into the LDPE registry. A
person can enter in as a pair with an
incompatible recipient, or a person
can be entered into the Registry
alone with the intention of donating
a kidney to a stranger (altruistic
donor). TT
Donation After
Cardiac Death
By Michael Williams
freelance writer
Last November, St. Paul’s
Hospital in Vancouver quietly became
the first in BC to implement a procedure
for organ retrieval that could
considerably increase the number of
life-prolonging transplants.
The procedure, known as donation
after cardio circulatory death,
or DCD, involves the removal of life
support from patients where death is
imminent. With the blessing of family
members, the assisted-breathing device
and other life support is removed
and, after the heart stops beating and
two physicians from the ICU certify
the patient has died, organ retrieval
begins within minutes.
Rigorous protocols had been
put in place at St. Paul’s; experience
from other hospitals worldwide, including
ones in Ontario and Quebec,
thoroughly analysed. The intensivecare
unit (ICU) and the transplant
team— keenly aware of each other’s
very separate, but nonetheless interwoven,
responsibilities —were set.
The implementation date for
the DCD protocols was Nov. 1 and the
preliminary estimate was that three
such procedures would be carried out
in the first year. Within a month, that
number had already been reached.
The following looks at the
re-emergence of DCD and the procedure’s
inherent medical and ethical
dilemmas.
--------
In their book, The Ethics of Organ
Transplants, Arthur Caplan and
Daniel Coelho say in the opening
chapter: “The boundaries of life and
death are not as clear today as in
the past.”
That observation remains
every bit as relevant more than a
decade after the book’s publication.
In 1968—the year of the first heart
transplant in the US and Europe’s
first lung transplant—a special committee
at Harvard University wrote
the definition of brain death—
becoming widely accepted as the
definition of end of life.
Doctors looked for neurological
activity in the brain—essentially
the nervous system. If there
was none, the person was deemed
dead.
If organs met the criteria for
transplantation (assuming that was
the declared wish of the decedent),
they were retrieved.
The concept of brain death
became widely accepted as an
ethical and legal criterion for organ
donation, a practice known as
donation after neurological determination
of death, or DNDD.
However, before the Harvard declaration,
organs were retrieved after
cardiac death, essentially following
the same methods as DCD. The
university’s declaration, later called
the dead-donor rule —seemed, in
hindsight, to have obscured the
concepts surrounding death and
donation.
The debate between
cardiac and brain death began. But
even today the issues are debated
mostly in medical and ethical journals.
Page 3 Transplant Times 2009