Non-heart-beating donors: One response to the organ shortage

The use of organs from NHBDs is beginning to gain acceptance as a method to help alleviate the current organ shortage. This is shown by the number of OPOs that now have protocols for retrieving organs from NHBDs. In a controlled setting, NHBDs can be expected to yield kidneys and, in preliminary studies, extrarenal organs that function similarly to those retrieved from HBDs. The best method of renal preservation after retrieval from NHBDs appears to be machine perfusion—as a result of which, rates of delayed graft function can be reduced significantly. Experimental work may help further limit the damaging effects of warm ischemia.

Although controlled NHBDs could have a significant impact on extrarenal transplantation, the impact on renal transplantation will be much smaller. For this reason, in the absence of HBDs, kidneys from uncontrolled NHBDs could have the most significant impact on decreasing the disparity between donors and potential renal recipients. However, protocols involving uncontrolled NHBDs are logistically more complex and must limit warm ischemia while, at the same time, satisfying issues of consent for any procedure performed in preparation for organ donation.

Because a large number of healthcare professionals are involved with potential NHBDs, discussions with them and with on-site ethics committees are extremely important. Although the use of NHBDs has a historical precedent, many are unaware that this concept is not new. Therefore, education of these same healthcare professionals is essential. Likewise, the transplant institution by way of medical boards or IRBs should approve protocols that involve the use of NHBDs. Active discussions regarding NHBDs should help allay any fears of impropriety and should help to maintain public trust. If our approach to NHBDs is scientifically sound, ethically based, and expertly applied, the use of NHBDs can be expected to have a major impact on organ donation. Despite this resurgence of interest in NHBDs, we must not lose sight of the fact that we can and must do more to realize the full potential of HBDs.