search efforts in these areas continue (see, for example, Magliocca et al., 2005) and need to be bolstered.

Prior Reports and Recommendations

IOM has released two previous reports on DCDD, formerly known as non-heart-beating organ donation (NHBD) and donation after cardiac death. The first report, Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement, undertaken at the request of the U.S. Department of Health and Human Services and published in 1997, noted that organ donations from living donors and DNDD donors would not bridge the widening gap between organ supply and demand in the United States (IOM, 1997). Despite the clear need to increase the rates of organ donation, the report found that the majority of transplantation programs in the United States did not have a mechanism or protocol for organ recovery after DCDD. The small number of programs with active involvement in DCDD concentrated virtually all of their efforts on controlled DCDD (Cooper et al., 2004).

Although implementation of uncontrolled DCDD protocols and programs is recognized as an opportunity to greatly increase the number of potential organ donors (especially kidney donors), the need to limit the warm ischemia time by means of early postmortem cannulation and cooling has raised the fundamental ethical issue of initiating organ preservation before informed consent is obtained from family members. At the time that the IOM report was published, enabling legislation existed in several other Western democratic countries and in three jurisdictions in the United States (Washington, D.C., Virginia, and Florida) that allowed this practice while the next of kin were being sought for permission for organ recovery (IOM, 2000).

Strong opposition to this position was taken by the American Society of Transplant Physicians (ASTP), who articulated the following reservation: “Uncontrolled NHBDs do not meet the principles of the ASTP, particularly in the area of consent, and therefore, the ASTP does not support the widespread use of this organ source” (IOM, 1997, p. 80). Perhaps in consideration of this testimony, which was concordant with several surveys of public sentiment conducted at the time, the IOM committee concluded: “Cannulation and cooling without consent may be a situation in which a decision based on deference to what the public is prepared to accept may be the wisest policy at the moment” (IOM, 1997, p. 55).

Despite this constraint placed on uncontrolled DCDD, the IOM committee concluded that “the recovery of organs from NHBDs is an important, medically effective, and ethically acceptable approach to reducing the gap that exists now and will exist in the future between the demand for and



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