Geven en nemen - dr Erwin JO Kompanje

to be fulfilled when organ donation is considered. Withholding ftuther treatment
from a patient, in whom all hope for recovery of brain function is lost, may be
considered before the ftllI situation ofbrain death has ensued, if such a patient is
unsuitahle for organ donation and such all approach may be considered good
medical practicc, preventing unnecessary use of scarce resources and unnecessary
prolongatiol1 of suffering for rclatÎvcs.
In the second part of this chapter the situation is discussed in which a dying
patient with a cerebrovascular accident is admitted to the intensive care unit with
the sole purpose of ",vaiting the development ofhrain death from the perspective
of organ donation. It is concluded that from the perspective of law and organ
donation in most cases this is not allowed and that it mar result in morally unacceptable
practice, because of conflict of interest and uncertain outcome.
In clmpters 6,7,8 atld 9 the possihility for organ procurement from non-heart
beating donors is discussed. The possibilities exists for procurement of kidneys in
patients with a systemic circulatory arrest with the so-called non-heart beating
donation procedure. In chapter 6 the definitions and clarifications of the nonheart
beating donor procedure are disctlSSed as weil as the declaration of death in
a non-heart beating donor. In a non-heart beating donor) in contrast to the suggestions
of the phrase) it is not the arrest of the heart) but the arrest of the circulation
of blood that is of importance. The pluase irreversible circulator}' arrest donor
is therefore more correct than non-heart beating donor. Following at least 10
mimltes of s}'stemic circulatory arrest the brain in an adult normothermic patient
has died and the patient may be considered dead. This opinion is supported by the
literature on resuscitation. In chapter 7 four categories of non-heart beatitlg
donors are discussed and analyzed (I dead on arrival; 2 unsuccesful resuscitationj
3 awaiting cardiac arrest! ventilator switch off and 4 brain dead). In relation to
non-heart beating donor procedures no accurate definition in the literature is
given on (dead on arrivar. The categories dead on arrival and unsuccesful resuscitation
should perferahly be viewed together. The different practical and ethical
problems presenting in these categories are discussed) including respect for
autonomy, respect fol' physical integrity and justice. Perfonning various invasive
procedures without explicit consent can not he justified by bellefit for others
(procurement ofkidneys). The question is addressed when a resuscitation
attempt may be considered unsuccesful. This is relevant to prevent a conflict of
interest behveen medical professionals in deciding behveen patient treatment
and treatment aimed at organ preservation. Consensus exists that resuscitation
is unsuccesful in an adult normothermic patient if perfonned for at least 30
minutes) because of asystoly or electromechanical dissociation and pupil reactivit}'
is negative) and for at least 45 minutes in the case of ventricular fibrillation)
despite reacting pupils.
Decisions on cessation of treatment) i.e. artificial ventilation) are discussed in
situations with and without the possibility of organ donation.lt appears difficult
412 5 U M MAR Y