From pittsburgh to Cleveland: NHBD controversies and bioethics

Cambridge Quarterly of Healthcare Ethics

Volumn 8, Issue 3, 1999, Pages 269-274

  Agich, George J ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

60 MINUTES (CBS NEWS TELEVISION PROGRAM); ARTICLE; BIOETHICS; BIOETHICS AND PROFESSIONAL ETHICS; CLEVELAND CLINIC FOUNDATION; DONOR; ETHICIST; HEALTH CARE AND PUBLIC HEALTH; HUMAN; INTERDISCIPLINARY COMMUNICATION; LONG TERM CARE; MEDICAL ETHICS; PERSONAL AUTONOMY; PROFESSIONAL STANDARD; STANDARD; TRANSPLANTATION; TREATMENT WITHDRAWAL; TRUST; UNITED STATES;

60 MINUTES (CBS NEWS TELEVISION PROGRAM); BIOETHICS AND PROFESSIONAL ETHICS; CLEVELAND CLINIC FOUNDATION; HEALTH CARE AND PUBLIC HEALTH;

BIOETHICAL ISSUES; ETHICISTS; ETHICS, MEDICAL; HUMANS; INTERDISCIPLINARY COMMUNICATION; LIFE SUPPORT CARE; OHIO; PENNSYLVANIA; PERSONAL AUTONOMY; PROFESSIONAL ROLE; TISSUE AND ORGAN PROCUREMENT; TISSUE DONORS; TRUST; UNITED STATES; WITHHOLDING TREATMENT;

EID: 0033146095     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0963180199803028     Document Type: Article

References (14)

1. Institute of Medicine. Non-heart-beating organ transplantation: medical and ethical issues in procurement. National Academy Press, 1997.
2. Arnold RM. Procuring organs for transplant: the debate over non-heart-beating cadaver protocols. Baltimore: Johns Hopkins University Press, 1995; [special issue]. Kennedy Institute of Ethics Journal 1993;3(2); Spielman B, ed. Organ and Tissue Donation: Ethical, Legal, and Policy Issues. Carbondale, 111.: Southern Illinois University Press, 1996.
3. Arnold RM. Procuring organs for transplant: the debate over non-heart-beating cadaver protocols. Baltimore: Johns Hopkins University Press, 1995; [special issue]. Kennedy Institute of Ethics Journal 1993;3(2); Spielman B, ed. Organ and Tissue Donation: Ethical, Legal, and Policy Issues. Carbondale, 111.: Southern Illinois University Press, 1996.
4. The Pittsburgh NHBD protocol was adopted in May 1992. See DeVita MA, Snyder JV. Development of the University of Pittsburgh Medical Center policy for the care of terminally ill patients who may become organ donors after death following the removal of life-support. Kennedy Institute of Ethics Journal 1993;3(2):131-43.
5. The wider history of asystolic organ donors is also reviewed in DeVita MA, Snyder JV, Grenvik A. History of organ donation by patients with cardiac death. Kennedy Institute of Ethics Journal 1993;3(2):113-29.
6. A corollary criticism, repeatedly made by the professor, was that the draft protocol contained a reference to ascertaining death by "carotid pulse" upon disconnection from life-support. This was taken as evidence that the physicians would rely on this clinical method when the use of regitine, a drug that lowers blood pressure, would obfuscate the determination of irreversible asystole. This belief persisted despite the fact the CCF protocol required that the patient be transported to the operating room with life-support and monitoring in place. Anyone with clinical experience would have realized that the patient would have to be taken to the operating room on monitored life-support. Checking the carotid pulse after withdrawal of life-support is a direct, hands-on corroboration that the asystole detected by cardiac monitoring was not a monitoring error. It is routinely, perhaps even symbolically, used to validate that a patient has died per the discontinuation of life-support. It did not represent a regression from more accurate and reliable electronic monitoring, as was suggested, to one that was ethically problematic, but rather represented a humane and symbolic addition to electronic instrumentation.
7. Spielman B, Verhulst S. Non-heart-beating cadaver procurement and the work of ethics committees. Cambridge Quarterly of Healthcare Ethics 1997;6:282-7.
8. Although the protocol was designed as a clinical, not a research protocol, it was also sent to the CCF IRB, which concurred that formal approval was not required since it did not involve research.
9. Letter to the Editor. Blowing the whistle on transplant protocol. Cleveland Plain Dealer 1997; May 21.
10. Rothman DJ. Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. New York: Basic Books, 1991.
11. Bioethics is listed in Smith-Maxey LR. Twenty-five hottest careers for women. Working Woman 1996; July.
12. One of the more outlandish was the use by CBS News in a promotion of the 60 Minutes story of an excerpt from a CCF videotape of a meeting with operating room personnel to discuss the protocol and to answer questions. The excerpt was taken totally out of context, which was an educational meeting that was videotaped for OR personnel who were not able to attend. The excerpt has the director of the neurosurgical ICU saying that the patient would not be dead when taken from the neurosurgical ICU. CBS used the excerpt to bolster the claim that CCF physicians intended to remove organs from living patients. However, the preceding and subsequent portions of the videotape show that the director of the neurosurgical ICU was explaining the process for complying with the family's request to withdraw life-support consistent with hospital ethics policy and state law. Although common enough in ICUs and other hospital settings, withdrawal of support is obviously unusual in operating rooms. The attempt to educate operating room personnel about the ethics and practice of withdrawal of life-support at the family's request was used to imply a sinister plan to callously take organs from vulnerable patients.
13. Agich GJ. The ethics of media bioethics. Bioethics Summer Retreat, Hilton Head, South Carolina, 11 June 1997.
14. The University of Wisconsin at Madison, for example, has always had an active NHBD program.