NON-HEART-BEATING ORGAN DONORS

A relatively recent development to increase the organ supply is the use of non-heart-beating organ donors. Originally introduced in the sixties, it was subsequently abandoned and has only recently been reintroduced. Medical centers re-explored this source of potential donors for abdominal organs (mainly kidneys). ^[21] In the United States, the use of organs from non-heart-beating donors steadily increased over the past decade, albeit at an overall low level. In 1993, the number of non-heart-beating organ donors was 42; it increased to 167 by 2001.^[22] Policies were developed by organ procurement officials and hospitals to allow organ donation as an option to be considered by relatives of patients who potentially qualify as non-heart-beating organ donors. Unlike brain-dead donors, whose heart function, circulation, and tissue oxygenation are preserved until the organs are retrieved, organs from non-heart-beating donors can be removed only after cardiac arrest. The difference invariably introduces a more significant warm ischemia time that can potentially result in suboptimal donor organs. Non-heart-beating donors can be categorized as controlled or uncontrolled, and these categories determine the extent of warm ischemia experienced by the organ donors. Controlled non-heart-beating donors are those for whom the transplant team is awaiting the cardiac arrest and all necessary preparations for rapid organ harvest are in place. In contrast, uncontrolled non-heart-beating donors are those who have suffered unanticipated cardiac

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