(Press-News.org) The American Thoracic Society has released an official statement on the ethical and health policy considerations surrounding adult and pediatric controlled organ donation after circulatory determination of death (DCDD), the recovery of organs after cessation of circulation from patients with severe neurological, neuromuscular or pulmonary disease for whom decisions are made to forego additional life-prolonging treatments.
The ATS developed the statement with input from the Society of Critical Care Medicine, the International Society for Heart and Lung Transplantation, the Association of Organ Procurement Organizations, and the United Network of Organ Sharing.
The statement appears in the July 1, 2013, issue of the American Journal of Respiratory and Critical Care Medicine.
"The recovery of viable organs must be performed with maximum respect for dying patients and their families," said Cynthia Gries, MD, MSc, assistant professor of medicine and clinical translational sciences in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pittsburgh Medical Center and chair of the committee that drafted the statement. "With that goal in mind, we developed a framework to help guide the various stakeholders involved in the DCDD process."
Recommendations in the statement include the following:
Consent
When patients themselves have consented to organ donation, hospital critical care and organ procurement organization (OPO) representatives should respect the patient's decision and provide this information to surrogate decision makers.
After clinicians lead discussions with patients or surrogates about the decisions to withdraw life-sustaining therapies, discussions about DCDD should proceed promptly and be coordinated jointly by clinicians and OPO representatives.
Consent for DCDD should be obtained by individuals with appropriate experience and training; these individuals' organizational affiliations should be disclosed clearly.
Interventions
Use of ante-mortem interventions and medications should be disclosed to surrogates at the time of consent and identified as being administered solely for the purpose of organ donation.
Ante-mortem interventions are ethically appropriate if they contribute to good transplant outcomes and have a low chance of harming the prospective donor.
Post-mortem donor management interventions that may stimulate physiologic functions require further analysis of their clinical usefulness and ethical merit.
Determination of death
Death can be declared after the cessation of circulation and respiratory function for 2 minutes.
Information about how death will be determined should be provided to the patient or the surrogates.
End-of-life care
Surrogates should be informed during the consent process regarding: (1) how and where life-sustaining therapies will be withdrawn, (2) the amount of time they can spend with their loved one post mortem and (3) the possibility that the patient may not die within the time interval necessary for DCDD to occur.
Hospitals that participate in DCDD should ensure that experienced personnel with competency in palliative care are available to participate in end-of-life care if needed.
Hospitals that participate in DCDD should have a clear policy regarding how and where patients will be cared for if they do not expire within the time interval acceptable for donation.
Pediatric DCDD
Although pediatric patients cannot provide consent to their own donation, consent of the parent or of another legal surrogate can be used.
The ethical principles related to consent, intervention, declaration of death and end-of-life care in pediatric DCDD patients are similar to those for adults.
"Increased use of DCDD organs could have a substantial impact on the chronic shortage of donor organs available for transplantation, but as the consent and management of potential DCDD donors occurs before death, it raises a number of important ethical and policy issues," Dr. Gries said. "This statement, which incorporates input from a number of critical care and transplant societies, addresses those issues."
###
About the American Journal of Respiratory and Critical Care Medicine:
With an impact factor of 11.080, the AJRRCM is a peer-reviewed journal published by the American Thoracic Society.It aims to publish the most innovative science and the highest quality reviews, practice guidelines and statements in the pulmonary, critical care and sleep-related fields.
Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society's 15,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy.
ATS publishes statement on organ donation after circulatory determination of death
2013-07-01
ELSE PRESS RELEASES FROM THIS DATE:
DNDi and Cipla advance development of pediatric 4-in-1 ARVs to fulfill new WHO guidelines
2013-06-30
The World Health Organization's new HIV treatment guidelines, released today at the 2013 International AIDS Society (IAS) Conference, include new antiretroviral (ARV) therapy (ART) recommendations for HIV-infected children, and will mean that more children will be on better treatments. The Drugs for Neglected Diseases initiative (DNDi) applauds the new guidelines and, with Cipla Ltd. and other partners, is expediting the development of urgently needed 4-in-1 ARVs adapted for babies and toddlers with HIV, to be delivered by 2015.
The new 2013 WHO Consolidated Guidelines ...
Biomarker predicts risk of breast cancer recurrence after tamoxifen treatment
2013-06-29
A biomarker reflecting expression levels of two genes in tumor tissue may be able to predict which women treated for estrogen-receptor (ER)-positive breast cancer should receive a second estrogen-blocking medication after completing tamoxifen treatment. In their report being published online in the Journal of the National Cancer Institute, Massachusetts General Hospital (MGH) Cancer Center investigators describe finding that the HOXB13/IL17BR ratio can indicate which women are at risk for cancer recurrence after tamoxifen and which are most likely to benefit from continuing ...
Late bedtimes and less sleep may lead to weight gain in healthy adults
2013-06-29
DARIEN, IL – A new study suggests that healthy adults with late bedtimes and chronic sleep restriction may be more susceptible to weight gain due to the increased consumption of calories during late-night hours.
In the largest, most diverse healthy sample studied to date under controlled laboratory conditions, results show that sleep-restricted subjects who spent only four hours in bed from 4 a.m. to 8 a.m. for five consecutive nights gained more weight than control subjects who were in bed for 10 hours each night from 10 p.m. to 8 a.m. The study found an overall increase ...
Survival of the Galapagos sea lion
2013-06-29
IMMUNE systems of endangered Galapagos sea lions are in overdrive because of harmful activity by people, reveal scientists from the Zoological Society of London (ZSL).
The study shows that Galapagos sea lions (Zalophus wollebaeki) are more prone to starvation because of exposure to human influences like pets and pollution. These can impair the level of their immunity, making them less able to hunt and more likely to go hungry when food is scarce.
This research is published today (28th June) in the journal PLOS ONE.
Conservationists spent more than eighteen months ...
Pre-existing insomnia linked to PTSD and other mental disorders after military deployment
2013-06-29
PHILADELPHIA - A new study from the Perelman School of Medicine at the University of Pennsylvania and the Naval Health Research Center has shown military service members who have trouble sleeping prior to deployments may be at greater risk of developing posttraumatic stress disorder (PTSD), depression and anxiety once they return home. The new study, published in the July 2013 edition of the journal SLEEP, found that pre-existing insomnia symptoms conferred almost as a large of a risk for those mental disorders as combat exposure.
"Understanding environmental and behavioral ...
Disney Research automates analysis of field hockey team behaviors
2013-06-29
Investigators at Disney Research, Pittsburgh, have developed an automated technique for analyzing the patterns of play of field hockey teams, providing a new tool for coaches and commentators who must make sense of mountains of video and other game data.
Because players constantly change roles during the flow of play – a left winger switching temporarily with a right winger, or vice versa – the researchers found that focusing on player roles, rather than the identity of an individual, was best for detecting the tactics, strategy and style of play for each team. The ...
Cardiac patients given longer prescriptions at discharge more likely to continue taking medication
2013-06-29
Elderly cardiac patients prescribed heart medications for 60 days or more after leaving hospital have four times the odds of adhering to the drug regime than patients prescribed the same medications for 30 days, according to research conducted at the Institute for Clinical Evaluative Sciences (ICES) and Women's College Hospital (WCH).
The study, published today in the Canadian Journal of Cardiology, found longer initial prescriptions when leaving hospital are associated with long-term adherence in elderly patients. The findings suggest prescriptions covering a longer ...
Divorce early in childhood affects parental relationships in adulthood
2013-06-29
June 28, 2013 - Divorce has a bigger impact on child-parent relationships if it occurs in the first few years of the child's life, according to new research. Those who experience parental divorce early in their childhood tend to have more insecure relationships with their parents as adults than those who experience divorce later, researchers say.
"By studying variation in parental divorce, we are hoping to learn more about how early experiences predict the quality of people's close relationships later in life," says R. Chris Fraley of the University of Illinois at Urbana-Champaign. ...
Mimicking living cells: Synthesizing ribosomes
2013-06-29
Synthetic biology researchers at Northwestern University, working with partners at Harvard Medical School, have for the first time synthesized ribosomes -- cell structures responsible for generating all proteins and enzymes in our bodies -- from scratch in a test tube.
Others have previously tried to synthesize ribosomes from their constituent parts, but the efforts have yielded poorly functional ribosomes under conditions that do not replicate the environment of a living cell. In addition, attempts to combine ribosome synthesis and assembly in a single process have ...
Rapid colorimetric detection technology enables illegal cooking oils with no place to hide
2013-06-29
In recent years, illegal cooking oil incident led to the serious food safety risks and the negative social repercussions. Professor HE Yujian and his group from College of Chemistry and Chemical Engineering, University of Chinese Academy of Sciences establish two rapid and convenient colorimetric detections of illegal cooking oils based on phase transfer technology. This work could be helpful for the rapid and on-site detection of illegal cooking oil. Their work, entitled "Rapid colorimetric detection of illegal cooking oils based on phase transfer technology", will be ...