THE ARTICLE “Attitudes Regarding Organ Do-nation From Non–Heart-Beating Donors” is

a timely article that provides a foundation onwhich to build further consensus discussionsabout the role of non–heart-beating donation(NHBD) in Canada. The authors are to be com-mended for elucidating relevant issues, identify-ing important parties in the dialogue, and high-lighting factors that correlate to one’s decisionabout donation in this context. Indeed, it is clearthat further exploration of this option in a widerforum is warranted. Support for pursuing such adiscussion may be found on both ends of the do-nation continuum.

As noted in the article, the growing discrepancybetween the number of people awaiting an organtransplant and the number of organs donatedrepresents a strong impetus for considering addi-tional sources of organs for transplantation. Ofequal importance, however, is the ability of thehealth care system to respond to a patient or fam-ily’s desire to donate at the end of life. Statisti-cally, a relatively small proportion of people whodie in a Critical Care Unit meet established brain-death criteria. A much greater proportion of thepopulation (in this study, 40% of the generalpublic and 81% of health care workers) indicatethey would always donate organs on death, giventhe opportunity. On occasion, physicians haveencountered the scenario in which a patient’s lovedones wish to pursue organ donation, but the patienthas not reached the point of brain death, nor isprogression in that direction expected. Were theoutstanding issues related to NHBD resolved andclear protocols in place, physicians and the healthcare team would be able to respond to the family’sdesire to donate by offering NHBD as an optionin these cases. NHBD is already an option in partsof Europe and the United States, and the issuecontinues to emerge on the agenda of nationaland international meetings of relevant health careprofessionals.

Determining the point at which further care is

futile remains a central issue in the discussionof NHBD. To that end, the authors recommendthe development of guidelines to establish a pro-cedure or process for defining that point. Of inter-est, the procedural parameters noted will also havea positive impact on organ donation if applied con-sistently as part of end-of-life care for all patientswho meet, or are expected to meet, brain-death cri-teria. Specifically, implementing a process in eachhospital that meets the following parameters willmove us closer to the goal of ensuring we give pa-tients and families the “gift of informed choice” re-garding organ and tissue donation in all appropri-ate circumstances:

According to the article, process parameters:

• Identify the individuals who should participate inrelated discussions;

• Specify how often these individuals should meet;• Establish a method for preventing or resolving

potential conflicts;• Render decision making about donation

transparent;• Explicitly incorporate the beliefs, values, and

preferences of the patient and family into thedecision;

• Ensure early and frequent communication and theparticipation of the patient and/or family mem-bers in the decision-making process.

Thus, while the discussion of the role of NHBDin Canada evolves, we as a health care communityhave the opportunity to make a more immediate

NON–HEART-BEATING CADAVER DONOR 37

COMMENTARY

Attitudes Regarding Organ Donation FromNon–Heart-Beating Donors: A Comment

Tracey Carr

From the Multiple Organ Retrieval and Exchange, UniversityHealth Network, Toronto, Ontario.

Address reprint requests to Tracey Carr, RN, BScN, MBA(c),M.O.R.E. (Multiple Organ Retrieval & Exchange), Toronto Re-gion, LuCliff Place, Suite 2108, 700 Bay St, PO Box 152,Toronto, Ontario M5G 1Z6.

Copyright 2002, Elsevier Science (USA). All rights reserved.0883-9441/02/1701-0005$35.00/0doi:10.1053/jcrc.2002.33034.

difference by improving existing processes and,thereby, increasing the number of donations fromthe traditional pool of potential donors.

NHBD is a challenging issue with rich clinicaland ethical dimensions that require concerted ex-ploration. The final decision regarding NHBD inCanada must be informed by the collective wisdom

of a diverse group of stakeholders, including thepublic. Although future directions in this regard re-main undefined across the nation, the authors ofthis article have contributed significantly to the nec-essary discussion by capturing the perspective ofthe populace and placing the issue within a Cana-dian context.

38 KEENAN ET AL