Organ donation after neurologically unsurvivable injury: a case study with ethical implications for physicians

Marisa Valdes, RN, BSN, Gay Johnson, BA, and James A. Cutler, CPTC

From Southwest Transplant Alliance, Dallas, Texas.

Corresponding author: Gay Johnson, BA, Southwest Transplant Alliance, 3710 Rawlins, Suite 1100, Dallas, Texas 75219 (e-mail: gjohnson@organ.org).

Today almost 80,000 patients are waiting for a vascularized organ for transplant in the USA, and >6500 patients each year die while waiting because an organ did not become available (1). With almost 18 patients a day experiencing preventable death, we are facing a national crisis in transplantation.

Physicians are recognized as the central figures in the delivery of health care, not only by other health care providers but also, most importantly, by their patients and their patients' families. As such, physicians play the first and frequently the most crucial role in whether a patient who has sustained a lethal neurological injury becomes an organ donor.

We present a case study of a patient who sustained a neurologically unsurvivable injury and the sequence of events involved in the care of this patient up to and including organ donation. We identify and discuss the ethical implications involved at each critical stage in the care of this type of patient and the steps needed to support the family of the patient and to facilitate an optimal organ donation process. (BUMC Proceedings 2002;15:129-132)