At St. Louis Children’s Hospital the protocol for the ‘non heart beating donor’ is this:

-Despite the name, start with a patient whose heart is very much still beating.
-This patient is alive by virtue of some measurable brain function and a natural circulation is expected to expire soon despite ongoing critical care
-If their organs meet criteria for donation and the family consents then
-The surgical team assembles in the OR
-The patient is transported from the ICU to the OR
-When everyone is ready, the skin is prepped for surgery and the harvest team prepared, the life support (usually a breathing machine) is turned off
-If the patient’s heart stops within 30 minutes the surgeons cuts.
-If the heart does not stop then the patient is returned to the ICU to await death. The ventilator may or may not be turned back on.

Under the former rules of brain death criteria at least the patient was dead. The brain dead exam is quite specific and the person is unequivocably all dead when the brain is dead.

But this new procedure is to take advantage of organs from the patient who is not dead yet, but probably will be dead soon. Successful harvest depends upon knowning exactly when the patient will become all dead and thus the incentive to actively schedule the death by pulling the plug after the patient is ready for harvest.

All of the anesthesiologists in our group have refused to participate in this practice. We’ve even agreed that we would not alter schedules for regular patients to accomodate this practice. Since we don’t control the facility otherwise we cannot stop the Critical Care physicians, lead by Allan Doctor (yes, his real name) from this practice.