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Ethical, Psychosocial, and Public Policy Implications of Procuring Organs From Non—Heart-Beating Cadaver Donors

Stuart J. Youngner, MD; Robert M. Arnold, MD; James Burdick, MD; Arthur Caplan, PhD; James Childress, PhD; David Cole, PhD,; Michael DeVita, MD; Renee Fox, PhD; Joel Frader, MD; Ake Grenvik, MD; Joanne Lynn, MD; Howard Nathan; John Robertson, JD; Byers Shaw Jr, MD; James Snyder, MD; Thomas Tomlinson, PhD; Alan Weisbard, JD; Zane Wolf, RN, PhD
JAMA. 1993;269(21):2769-2774. doi:10.1001/jama.1993.03500210069034.
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A SHORTAGE of transplantable organs is a constant and frustrating reality. With continued progress in organ transplantation, the demand for transplants, and thus the need for organs, has increased markedly. The result is an increasing shortage of organs and longer waiting lists for transplantation. As of May 7, 1993, there were 31 303 people awaiting organ transplants (Dave Lohrey, United Network for Organ Sharing Data Base, oral communication, May 7,1993). One third of patients awaiting liver or heart transplants currently will die awaiting an organ, while patients awaiting renal transplants must tolerate a less acceptable quality of life undergoing dialysis.1

Most organs come from patients who have been declared dead by neurological criteria—ie, they have irreversibly lost all brain function and their bodies are being maintained on ventilators in intensive care units. They are commonly referred to as heart-beating cadaver donors (HBCDs) because their hearts are beating at the


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