'Dead' man wakes as transplant surgeons prepare to remove his organs
Posted Sep 22 2008 6:06am
While we in the United States are working through some of the fuzzy edges of DCD, the Frenchand British are similarly struggling with NHBOD. The British Telegraph reported yesterday that a man whose heart had stopped beating woke up just as surgeons were about to remove his organs for donation.
Doctors in Paris earlier this year called in transplant surgeons after failing to resuscitate a 45-year old man believed to have suffered a massive heart attack in the French capital.
According to a report by the Paris university hospital's ethics committee - seen by Le Monde newspaper - doctors continued providing a heart massage for an hour and a half while they waited for the surgeons to arrive.
When the surgeons began operating on the man to remove his organs, he began to breathe, his pupils became responsive and he reacted to a pain test.
"After a few weeks chequered with serious complications, the patient is now walking and talking," said the report. It is not known whether the man is aware of how close he was to losing his organs.
The incident highlights the ethical problems doctors face in deciding when a donor is really dead.
Emergency service staff interviewed in the report said they knew of other situations where "a person who everyone was convinced was dead survived after prolonged re-animation moves well beyond usual timeframes or even those considered reasonable."
They pointed out that if they had followed the rules to the letter, such patients "would probably have been considered deceased."
In particular, the case is likely to ignite public debate over so-called controlled non-heart-beating organ donation (NHBOD) – retrieving organs when the heart stops, which has only been legal in France since last year. Before then a patient had to be declared brain dead before transplant could occur. NHBOD is legal in the UK.
"All specialised medical literature on the subjects allows one to conclude that a person who has suffered cardiac arrest and has had proper heart massage for over 30 minutes is, for all purposes, brain dead," said Professor Alain Tenaillon, in charge of organ transplants at France's biomedical agency. "But one must acknowledge that exceptions do exist ... there are no hard and fast rules on best practice," he told Le Monde.
Some 13,000 people are awaiting organ donations in France, a far higher number than in Britain, with 7,700 awaiting organs, despite France's a so-called opt-out system. This means everyone gives their "presumed consent" to having their organs removed after death unless either they have refused permission or if their family objects.
In the UK, people "opt in" to the donation system by carrying a donor card or signing the Organ Donor Register. A Department of Health task force is currently looking into the opt-out system.