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NHMRC calls for calm in organ-donation-after-death debate
The National Health and Medical Research Council is currently undertaking a routine review of its guidelines on the ethical issues surrounding organ and tissue donations after death. A three-month period of public consultation has just concluded.
We wish to clarify some of these ethical issues following potentially confusing information in recent media coverage. This is of concern to us because the information might have an adverse impact on the donation rate of critically-needed organs and tissues.
Suggestions in the media have been that in order to increase organ donation rates, health authorities are under pressure to allow doctors to obtain organs from patients who are still 'technically alive'.
The NHMRC wishes to reassure the public that this will not occur. It will continue to be illegal and unethical to remove organs before people are dead.
There is also no intention or need to change the definition of death to facilitate organ donations, or for any other purpose.
Doctors can make a diagnosis of death when there has been cessation of all brain function, or cessation of the circulation for such time that it cannot resume.
Where a patient is diagnosed as brain dead, medical teams can use life support techniques to keep circulation and breathing going to keep organs in good condition until they are transplanted.
One area that is being debated within NHMRC as well as in the community is where brain death has not occurred but cardiac death is imminent.
New technologies mean that in such circumstances non-harmful 'ante-mortem' procedures are possible. Ante-mortem procedures include injecting drugs such as anticoagulants that will not affect the patient's health, but will maximise the preservation of organs after death has occurred.
Many people think that this is reasonable when no harm is possible and there has been specific prior consent to ante-mortem procedures. In such circumstances the procedures are making the patient's express wish to donate much more effective.
Others say that ante-mortem procedures in such circumstances are unacceptable because the procedures are benefiting someone other than the patient.
The NHMRC welcomes community input on ethical issues because our guidelines must reflect current community values and thinking. We have received 73 submissions to our call for public comment, and they will all be carefully considered before we reach a final position, which will be by the end of the year.
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