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  • University of Pittsburgh Medical Center Policy and Procedure Manual

Subject: Management of Terminally Ill Patients Who May Become Organ Donors After Death

Date: May 18, 1992

I. Policy

The University of Pittsburgh Medical Center presently has Guidelines on Forgoing Life Sustaining Treatment (Policy #4007). Patients or their surrogates can decide to forgo life sustaining treatment and the Guidelines authorize comfort measures for patients wishing to forgo such treatment. Furthermore, all patients have the right to elect organ donation in the event of their death. For the last 20 years, the great majority of organ donors have been persons declared dead by brain death criteria. However, donation by persons who die from cardiac or respiratory failure is legal and was a commonly accepted practice before brain death criteria were established. The University of Pittsburgh Medical Center ("UPMC") believes that it is ethically appropriate to consider organ procurement from nonheartbeating donors. The purpose of this document is to provide an ethically justifiable and auditable policy that respects the rights of the patients to have life support removed and to donate organs if they wish to do so.

II. Principles

  1. A. Decisions concerning the treatment and management of the patients (including but not limited to the decision to withdraw mechanical support and/or medications) must be made separately from and prior to discussions of organ donation. This means that appropriate candidates for withdrawal of life support shall be identified independently of donor status. Consideration of organ donation shall occur only after a decision has been made by the patient, surrogate, or family and physicians that the patient be assigned the status of "comfort measures only" as indicated in the Medical Center's Guidelines on Forgoing Life Sustaining Treatment. Patients shall be considered for organ donation pursuant to this policy only when the patient or surrogate initiates discussion of organ donation. [End Page A-1]

  2. B. It is the health care professional's primary responsibility to optimize the patient's care. For example, the process of removing life support shall be done primarily to promote patient comfort and respect patient autonomy with regard to removal of life support and organ donation. It is an important objective of this policy that the interest in procuring organs does not interfere with optimal patient management.

  3. C. Appropriate candidates for organ donation shall be limited to those patients on life sustaining treatment in whom withdrawal of that therapy is likely to result in death within a few hours (for example, patients who are respirator or intra-aortic balloon dependent).

  4. D. Assuring patient comfort is the only indication for using medications, and the dose of the medications should be carefully titrated to this purpose.

  5. E. This policy explicitly prohibits any intervention whose primary intention is to shorten the patient's life. Any act which intentionally causes the death of a patient is forbidden.

  6. F. Utmost attention and caution shall be taken to protect the dignity and rights of donors.

  7. G. Health care professionals shall not be required to participate in the procedures described below if such participation is against their personal, ethical or religious beliefs.

  8. H. In this policy, the term "surrogate" decision maker is defined as specified in the informed consent policy of the Medical Center (Policy #4011). Unless otherwise indicated, the term "patient" includes the surrogate of a patient who lacks decision making capacity.

III. Procedures

  1. A. The detailed discussion of organ donation shall be deferred until after the decision to withdraw life support has been reached. An agreement between the patient and the attending physician that the patient is assigned the status of "comfort measures only" (as described in the Guidelines on Forgoing Life Sustaining Treatment) is required for the patient to be considered an organ donor according to this policy. The discussions with the patient, leading to the decision to withdraw all life sustaining therapy, must be appropriately documented in the medical record.

  2. B. After the decision to withdraw life support has been reached, the patient's attending physician or his/her designee, or the Center for Organ Recovery [End Page A-2] and Education (CORE), may discuss potential organ (and tissue and cornea) donation with the patient only if this discussion has been initiated...

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Additional Information

ISSN
1086-3249
Print ISSN
1054-6863
Pages
pp. A-1-A-15
Launched on MUSE
2009-01-01
Open Access
No
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