It is essential that all medical decisions regarding the potential donor be made by their physician team and family (as is the practice in all reputable transplant programs) If it is true that a member of the transplant team was allowed to terminate care, this is very disturbing and must be an exceptional event - based on 30+ years of ICU practice

Sent by Fred H, MD | 3:06 PM ET | 08-05-2007

As a Registered Nurse, and a Donation Coordinator with a local Donor Program, it is stories like this that send chills right through me, and disturb the peace and hope that donation can bring to many families.

In my years of work with families who are losing someone, it has always been amazing to watch the transformation that comes from a family having a conversation with a donation agency when they have lost their loved one. It takes the family from a place of loss with no other choice or control, to one of control and meaning. They are given the ability to create a legacy that not only can save lives, but can also honor their loved one's life in a very positive way.

I read once that there is only 1 way to die, but 2 ways to measure it.

Brain Death: where all functions of the brain cease, and the person is clinically dead, but may still appear alive, but is in fact being maintained on mechanical support to allow the family time for an educated decision about organ donation.

-and-

Cardiac Death: where the heart stops, and the person appears, and is, clinically dead.

This particular case involves the latter.

From what I have read, this patient came into the hospital with life threatening neurologic and physical injury, and the staff there worked with the mother to assess her and her son's wishes for not only quality of life, but also to what extent they were going to continue to medically treat. Somewhere in this time frame things leaned toward the mother deciding to withdraw treatment.

In very rare situations such as this, the family may presented with a choice. One that can save lives, answers prayers, and give meaning to such a horrible loss.

DCD. Donation after Cardiac Death.

It appears that was the situation with this young man, and his mother. Somewhere in the course of his hospitalization, the family decided that the medical treatment and level of support required to sustain their son's life was too great, and that mercifully, they chose to withdraw support and let god's plan work. If he was meant to live, he would, if he was to die, he would.

Following that decision to withdraw support, there was a discussion about donation with the mother, and consent for DCD donation appeared to have been given to allow this process to begin.

In these situations, if the person passes away within 60-90 minutes (depending on transplant center organ acceptance criteria); there is an opportunity for organ donation to take place. Typically the person is brought to the Operating Room, and the family is allowed to be present for the withdrawal of support, and to be there to be with their loved one, to hold their hand, to kiss them goodbye, and ensure that the process works as intended, all the way through to their death. If the person does not die within 60-90 minutes, they are to be cared for in a way that is the very same as if support had been withdrawn back at the hospital bed, with family at the bedside and as if donation had never entered the picture: Routine End of Life Care.

It is somewhere in that that setting, in the Operating Room, during the withdrawal of treatment that things went horribly in the wrong direction.

It is unethical that a transplant surgeon recovering organs be present in this setting, as this is the families sacred space. It is normal that the patient, the family, the Donation Coordinator supporting the family, the patient's nurse, a chaplain/pastor, and members of the hospital's surgery staff be present in the room during withdrawal. The transplant team that is recovering organs for transplant should never be allowed in the room until cardiac death has occurred so as not to create an unethical situation, which apparently happened in this case.

It is cases like this that will resonate in our family's minds when the time comes that they have lost someone and are presented with the opportunity to save lives through organ & tissue donation. This physician has no idea just how much damage he has done to a process that tries very hard to be as transparent as possible. For the public to trust the organ donation process, transparency is a must. Ethics are a must. Honesty is a must. I applaud the hospital and donation agency staff in this case that brought the information forward, as they knew this was not acceptable.

In the meantime, the waiting list continues to grow. Now reaching almost 97,000 people.

Moms, dads, brothers, sisters, daughters, sons, partners, and friends, whose lives absolutely depend on the very kind and generous life giving decision to donate. A decision that is made at a time when a family is experiencing great pain and loss, but are able to see that there is good that can come from a bad situation.

I only hope that the same can be said for this situation.

Sent by joshua korthouse | 11:08 AM ET | 08-06-2007

I ran across this site http://en.zoukiishoku.com/ and hope it is a hoax. They offer turn around time on a liver in MONTHS not years. In China they strip the organs out of people the state puts to death.

Sent by Ernest Seemann | 5:29 PM ET | 08-14-2007

All I can say is that I was renewing my CA driving license and was prompted to participate in the organ donation program. The NPR story of last week made me pass on this option, even though I always felt this was something I wanted to do... I am sure others might feel the same.

Sent by Julia | 12:32 AM ET | 03-09-2008