Table 5 Case illustration: donation of organs

A COMMUNITY hospital agrees to participate in organ harvest from non–heart-beating cadaveric donors (NHBCDs). Members of the anesthesiology department are informed that patients requiring life support will be transferred to the operating room, where an anesthesiologist will monitor them during preparation and draping for organ harvest. The anesthesiologist will discontinue life support and administer medications to keep the patient comfortable while he or she dies. Three minutes after asystole ensues, the anesthesiologist will pronounce the patient dead, and organ harvest will immediately begin.

The anesthesiologists question the ethics of stopping life support and then harvesting vital organs. Some believe it is acceptable to discontinue life support and administer medications to stop respirations and hasten death. Many are resentful that an unpleasant task is being thrust onto them by other physicians in a manner reminiscent of “orders to nurses.” Most express bewilderment that the duties of discontinuing life support, caring for the dying patient, and diagnosing and pronouncing death should fall to an anesthesiologist.

VanNorman [67]