On such a view, NHBD
protocols might have more in common with "conscience clauses" than is generally recognized.
Original work by the Maastricht NHBD group has established threshold limits for tGST activity in kidney perfusates for the selection of "viable" kidneys for transplantation (6).
The use of controlled and uncontrolled NHBD donors provided a differential ischemia model.
There were 31 (of a total of 70 NHBD kidneys procured) renal transplants using uncontrolled donors and 38 (of a total of 48 NHBD kidneys procured) renal transplants using controlled donors, with lower discard rates perceived with the controlled donors (Table 1).
11) That NHBD supporters define death in inconsistent and non-objective terms is demonstrated in a 1999 study of 108 patients.
The IOM also admits that a major concern in allowing NHBD is the question as to whether the cardiopulmonary resuscitation of a potential donor has been vigorous or sustained enough.
Reports and articles supporting NHBD deny that withdrawing ventilation is an ethical problem because the decision to do so is presumed to have been made before the decision to donate is made and independently of it.
26] Many in the transplant field see NHBDs as a key source to meet the growing demand for organs, and many other NHBD protocols have been proposed.
One was that the drugs administered prior to death in NHBD protocols--anticoagulants (heparin) and vasodilators (regitine) to minimize the effects of warm ischemia on organ viability--could hasten or even cause death.
34] However, it noted that "in the occasional NHBD with ongoing intracranial bleeding or deficiencies in blood volume" the administration of such agents "is not indicated because it could actively cause death" (p.
One of the more controversial topics the IOM faced was the timing of death in controlled NHBD protocols.
Two aspects of the legal criteria for death are relevant to the controlled NHBD protocols and the five-minute rule.