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Author Topic: NEJM: The Dead-Donor Rule and the Future of Organ Donation  (Read 3379 times)

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Offline Clark

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NEJM: The Dead-Donor Rule and the Future of Organ Donation
« on: November 04, 2013, 11:07:05 AM »
http://www.nejm.org/doi/full/10.1056/NEJMp1307220

The Dead-Donor Rule and the Future of Organ Donation
Robert D. Truog, M.D., Franklin G. Miller, Ph.D., and Scott D. Halpern, M.D., Ph.D.
N Engl J Med 2013; 369:1287-1289October 3, 2013DOI: 10.1056/NEJMp1307220

The ethics of organ transplantation have been premised on “the dead-donor rule” (DDR), which states that vital organs should be taken only from persons who are dead. Yet it is not obvious why certain living patients, such as those who are near death but on life support, should not be allowed to donate their organs, if doing so would benefit others and be consistent with their own interests.

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Our society generally supports the view that people should be granted the broadest range of freedoms compatible with assurance of the same for others. Some people may have personal moral views that preclude the approach we describe here, and these views should be respected. Nevertheless, the views of people who may freely avoid these options provide no basis for denying such liberties to those who wish to pursue them. When death is very near, some patients may want to die in the process of helping others to live, even if that means altering the timing or manner of their death. We believe that policymakers should take these citizens' requests seriously and begin to engage in a discussion about abandoning the DDR.
Unrelated directed kidney donor in 2003, recipient and I both well.
620 time blood and platelet donor since 1976 and still giving!
Elected to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, and Ad Hoc Public Solicitation of Organ Donors Committees, 2005-2011
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Offline Clark

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Life or Death for the Dead-Donor Rule?
« Reply #1 on: November 04, 2013, 11:09:16 AM »
Life or Death for the Dead-Donor Rule?
James L. Bernat, M.D.
N Engl J Med 2013; 369:1289-1291October 3, 2013DOI: 10.1056/NEJMp1308078

The increasing disproportion between the supply of donor organs and the demand for transplants as well as the tragic deaths of patients awaiting organs have encouraged the development of creative solutions to increase the donor supply. In the domain of donation from deceased donors, the protocols for organ donation after the circulatory determination of death (DCDD) have been one such response. Most U.S. organ-procurement organizations have seen organs from DCDD protocols account for a growing percentage of all organs donated from deceased donors.

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I favor strategies to increase the organ supply such as improving donation consent rates by enhancing family education and communication, optimizing end-of-life care for donors while supporting grieving families, and developing state donor registries to authorize first-person donor consent. Recognizing that the harms of abandoning the DDR exceeded the benefits, John Robertson proposed a two-part prudential test for assessing proposed changes to the rule, asking what effect they would have on the protection of vulnerable persons and on preserving the public trust.2 These essential questions need to be answered conclusively before our society considers abandoning the DDR.
Unrelated directed kidney donor in 2003, recipient and I both well.
620 time blood and platelet donor since 1976 and still giving!
Elected to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, and Ad Hoc Public Solicitation of Organ Donors Committees, 2005-2011
Proud grandpa!

 

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