Latest news with #organ donation
New York Times
5 hours ago
- Health
- New York Times
Donor Organs Are Too Rare. We Need a New Definition of Death.
People die in many ways, but in medicine there are only two reasons a person can be declared dead: Either the heart has stopped or the brain has ceased to function, even if the heart is still beating. A person may serve as an organ donor only after being declared dead. (Until then, transplant surgeons are not allowed even to interact with a dying patient.) This common-sensical rule underpins organ donation in the United States and many other countries. Most donor organs today are obtained after brain death, defined by most state laws as a condition of permanent unconsciousness with no spontaneous breathing, no response to pain and no primitive reflexes — in other words, devastation of the whole brain. Organs obtained this way are often relatively healthy, because brain-dead patients can continue to circulate blood and oxygen. Brain death is rare, though. In New York State, with a population of 20 million, there are on average fewer than 500 cases suitable for organ procurement and transplantation each year. Far more often, people die because their heart has permanently stopped beating, which is known as circulatory death. However, precisely because the blood has stopped circulating, organs from people who die this way are often damaged and unsuited for transplantation. The need for donor organs is urgent. An estimated 15 people die in this country every day waiting for a transplant. We need to figure out how to obtain more healthy organs from donors while maintaining strict ethical standards. New technologies can help. But the best solution, we believe, is legal: We need to broaden the definition of death. Consider how things currently work. In the procedure known as donation after circulatory death, a typical donor is in an irreversible coma from, say, a drug overdose or a massive cerebral hemorrhage, and the heart is beating only because of life support. The donor is still not legally brain-dead; he or she might have, say, a gag reflex or other primitive functions. In such cases, with the blessing of the family, a donor is brought into an operating room and life support is carefully withdrawn. If, as is expected, the removal of life support results in stoppage of the heart, surgeons will wait long enough to determine that the stoppage is permanent — to be confident of death — but not so long that vital organs get damaged. This period is typically about five minutes. Then the surgeons remove the organs. But even a few minutes of a stopped heart often results in damage to the organs. This deprives potential recipients of healthy organs and thwarts the wishes of donors to have their organs used to help others. Fortunately, there is a relatively new method that can improve the efficacy of donation after circulatory death. In this procedure, which is called normothermic regional perfusion, doctors take an irreversibly comatose donor off life support long enough to determine that the heart has stopped beating permanently — but then the donor is placed on a machine that circulates oxygen-rich blood through the body to preserve organ function. Donor organs obtained through this procedure, which is used widely in Europe and increasingly in the United States, tend to be much healthier. But by artificially circulating blood and oxygen, the procedure can reanimate a lifeless heart. Some doctors and ethicists find the procedure objectionable because, in reversing the stoppage of the heart, it seems to nullify the reason the donor was declared dead in the first place. Is the donor no longer dead, they wonder? Proponents of the procedure reply that the resumption of the heartbeat should not be considered resuscitation; the donor still has no independent functioning, nor is there any hope of it. They say that it is not the donor but rather regions of the body that have been revived. How to resolve this debate? The solution, we believe, is to broaden the definition of brain death to include irreversibly comatose patients on life support. Using this definition, these patients would be legally dead regardless of whether a machine restored the beating of their heart. So long as the patient had given informed consent for organ donation, removal would proceed without delay. The ethical debate about normothermic regional perfusion would be moot. And we would have more organs available for transplantation. Apart from increased organ availability, there is also a philosophical reason for wanting to broaden the definition of brain death. The brain functions that matter most to life are those such as consciousness, memory, intention and desire. Once those higher brain functions are irreversibly gone, is it not fair to say that a person (as opposed to a body) has ceased to exist? Understandably, some will worry that doctors will prematurely pronounce a patient irreversibly comatose when in fact the patient is not or there is genuine hope for recovery. This is rare, but it can happen (as recently documented by The Times), and when it does, it is a catastrophe. That sort of concern, however, is about practicalities such as whether doctors are following protocol properly and whether external pressures are creating perverse incentives for doctors and other medical workers to be careless. These are critical issues, to be sure. But it remains possible (and common) to responsibly determine whether someone is irreversibly comatose, and in such cases a judgment of brain death is merited, as the law should be revised to reflect. In 1968, a committee of doctors and ethicists at Harvard came up with a definition of brain death — the same basic definition most states use today. In its initial report the committee noted that 'there is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.' This frank assessment was edited out of the final report because of a reviewer's objection. But it is one that should guide death and organ policy today. Sandeep Jauhar (@sjauhar) is the author of 'Heart: A History' and a cardiologist at Northwell Health, where Snehal Patel and Deane Smith are the directors of the Center for Heart Failure, Transplant and Mechanical Circulatory Support. The Times is committed to publishing a diversity of letters to the editor. We'd like to hear what you think about this or any of our articles. Here are some tips. And here's our email: letters@ Follow the New York Times Opinion section on Facebook, Instagram, TikTok, Bluesky, WhatsApp and Threads.
ABC News
2 days ago
- Health
- ABC News
Legacy of ACT's first organ donor remembered 50 years on amid calls for more donors
Annette Taylor was just 11 when she suffered an unexpected cerebral brain haemorrhage.. However the darkness of her tragic death 50 years ago would become a life-saving moment as she became Canberra's first organ donor. "She came home from school and said she had a headache, later that night she was in hospital, unconscious, and passed away four days later," her brother Michael Taylor said. However the young girl had previously had several conversations with her mother Marjorie Taylor about wanting to donate her organs. Those conversations proved lifesaving. Mr Taylor's wife, Debbie, said her mother-in-law fought hard to honour her daughter's wish. "Canberra Hospital said 'no, can't happen' but Marj didn't take no for an answer." Eventually a specialist team from Sydney performed the procedure and Annette's two kidneys were given to a 40-year-old man and a 15-year-old boy, changing their lives. Annette became the ACT's first organ donor. Mr Taylor said the trauma of Annette's death had turned into a legacy honouring the caring girl who always went out of her way to help others. "It seems a bit like a bad dream which I had 50 years ago, but that dream has become an amazing legacy," Mr Taylor said. Annette's legacy will continue to live on with the ACT government announcing a street in the west Belconnen suburb of Macnamara will be named 'Annette Street'. Joshua Lindenthaler was diagnosed with a heart condition in 2008, which progressed to him needing a defibrillator, and then a transplant. The Canberra physiotherapist was fortunate, and just three months after being added to the transplant waitlist, he received a new heart in October 2021. "I had a big cardiac episode in the family home requiring CPR from a family member, so surviving that was a pretty big miracle — out of hospital CPR survival rate is five to 10 per cent," he said. Mr Lindenthaler was taken from Canberra Hospital to St Vincent's Hospital in Sydney, and about a week later a viable heart became available. "It's been amazing," he said. An avid cyclist, Mr Lindenthaler said he was living his life to the full and making the most of the gift he'd been given. "I've still got a lot of things I want to do and I want to achieve," he said. "And to try and help other people [by getting] people to register as donors so other people like myself can have a second chance." Only two per cent of people who die in Australian hospitals meet the criteria for donating their organs. One of the requirements is that they have to die in an intensive care unit or emergency department, as organs need to be functioning well to be considered for transplantation. According to data from DonateLife, there are around 1,800 Australians on the waitlist for an organ transplant and 14,000 more on dialysis — many of whom could benefit from a kidney transplant. About 50 Australians on the transplant list die each year because they are still waiting. Most Australians support organ and tissue donation, but only 36 per cent are registered donors. Only 28 per cent of Canberrans are registered. DonateLife ACT agency manager Nadia Burkolterm said the biggest barrier to organ donation was would-be donors not communicating with their loved ones. "More families will say no to donation than yes at that particular crisis moment if they haven't had a conversation that guides them at that time. "Visit the DonateLife website and it honestly takes less than one minute."
News.com.au
2 days ago
- Health
- News.com.au
AFL and Carlton player Zac Williams signs up to become a registered organ donor after finding out his wife already was
Zac Williams has kicked plenty of goals in his career as an AFL star. But a recent shift off the field has lead him to quite a different goal in his personal life. After a converstaion with wife Rachel Lucas, the Carlton Football player has signed up as a registered organ donor with DonateLife. 'I'm probably one of those people that have been oblivious for so long about organ donation,' Williams told Lucas, a former Ballerina, was already a registered organ donor and helped encourage the former GWS Giant to do the same, along with other family and close friends. 'It was actually a very passionate conversation that we had about it,' Williams said. 'Hearing stories from people that have received organ donations and how it saved their lives, was really inspirational. 'I was pretty easily convinced that if you become an organ donor how much you can help others.' The pair, who married in 2024 share two children, son Beckham and daughter Ayla. Williams' decision to register as a donor comes as the median time people currently on the kidney transplant wait list has risen to 2.6 years. The waiting period is dependant on individual's blood type and location, but is significantly higher than the average wait time for a liver transplant which is eight to 12 months. More than 200 Australians have died in the past five years waiting for a transplant, but there are concerns the figure may actually be higher as patients are removed from waitlists as they're conditions worsen. Williams is speaking ahead of DonateLife Week which aims to raise national awareness about organ and tissue donation between July 27 and August 3. Williams even let his good friend and rival AFL player from Port Adelaide Jeremy Finlayson know he'd made the move. Finlayson's wife Kellie was diagnosed with Stage four bowel cancel at 25 years old in 2021, after giving birth to their daughter Sophia just three months prior. Not long later in 2022 after experiencing shortness of breath, it was confirmed the disease had spread to her colon. Kellie has been receiving blood from donors helping save her life following surgeries and ongoing treatment. Williams meanwhile is facing a tough uphill battle with a struggling Carlton side that have slumped to 12th in this season's standings. The 2013 AFL rising star has seen a positional shift at times and has been a consistent member of the squad.
SBS Australia
4 days ago
- Health
- SBS Australia
SBS News in Filipino, Sunday 27 July 2025
Australia's defence minister hails a deal with the UK on AUKUS. The Organ and Tissue Authority is encouraging Australians to have a conversation about registering as organ and tissue donors while the country celebrate DonateLife Week this July 27 to August 3. The Philippine government has advised Filipinos not to travel to areas in dispute in Thailand and Cambodia as clashes between the two countries continue. LISTEN TO THE PODCAST SBS Filipino 27/07/2025 06:47 Filipino 📢 Where to Catch SBS Filipino 📲 Catch up episodes and stories – Visit or stream on Spotify , Apple Podcasts , Youtube Podcasts , and SBS Audio app.
Medscape
7 days ago
- Health
- Medscape
CMS Review of Organ Procurement Organizations Sparks Debate
In late May, the Centers for Medicare & Medicaid Services (CMS) released its latest performance report for the nation's 55 Organ Procurement Organizations (OPOs), the nonprofits responsible for recovering organs from deceased donors. The 2025 report shows notable improvements from the 2003 assessment with the number of lowest-performing Tier 3 OPOs declining from 24 (42%) to 10 (18%), and the number of top-performing Tier 1 OPOs doubling to 30 (54%). However, a plan by CMS to begin revoking the certification of Tier 3 OPOs following the 2026 report has heightened an ongoing debate about the reports' accuracy, fairness, and repercussions. The Report CMS began ranking OPO performance in 2022 as part of a larger effort to modernize the nation's transplant system following years of criticism that it was inequitable and inefficient. Each annual CMS assessment uses data from 2 years prior (eg, the 2025 assessment reflects 2023 data). CMS then applies two metrics to measure OPO performance: Donation rate: the percentage of potential donors from whom at least one organ was transplanted the percentage of potential donors from whom at least one organ was transplanted Transplantation rate: the number of transplanted organs as a percentage of potential donors Potential donors are defined as hospital patients ≤ 75 years whose deaths are compatible with donation. CMS then compares each OPO against the prior year's national data. The top 25% are designated Tier 1, those below the prior year's median are placed in Tier 3, and those in between are assigned Tier 2. To date, CMS has never revoked an OPO contract — but that will change with the 2026 performance assessment. At the end of the current 4-year contract cycle next year, all Tier 3 OPOs will be decertified and higher-performing OPOs will be able to bid for their contracts. Tier 2 OPOs will also have to compete with other interested OPOs to keep their service areas. Disputing the Metrics The improved OPO performance in the 2025 report is 'the result of greater transparency and accountability associated with the current outcome measures,' a CMS spokesperson told Medscape Medical News . The new outcome measures 'obviously would light a fire' under OPOs striving to improve, said Jeff Trageser, president of the Association of Organ Procurement Organizations (AOPO) and the executive director of Livesharing, a consistently Tier 1 OPO based in San Diego. Many OPOs, he noted, have been investing heavily in advocacy to convert eligible deceased donors into actual donors, tailoring donation strategies to their communities, and expanding organ offers to distant transplant centers to reduce the number of discarded organs. AOPO and its 47 member organizations have raised multiple objections. Trageser called CMS' performance assessments seriously flawed and warned they could penalize OPOs making steady progress. OPOs shouldn't be held accountable for transplant numbers as hospitals decide which organs to accept or reject, Trageser said. Sean Fitzpatrick, chief public affairs officer at New England Donor Services (Tier 2), argued in a recent statement that CMS' methodology unfairly penalizes large OPOs. A recent simulation study published in American Journal of Transplantation made a similar claim, suggesting the system 'systematically identifies larger OPOs as underperforming.' But CMS disagrees, noting through its spokesperson that 'both large and small OPOs have moved among performance tiers [from year to year], indicating that success is driven by operational effectiveness, not size.' Regional Differences a Concern David DeStefano, president and CEO of We Are Sharing Hope SC in Charleston, South Carolina, said his OPO has boosted donations and transplantations by 30% since 2017 through community partnerships and better coordination with transplant centers. Yet the OPO remains in Tier 3, which he attributes to higher rates of diseased, unusable organs in his largely rural service area that lacks access to health care. CMS should risk-adjust the performance metrics to reflect geographic differences in sociodemographic factors, he said. The CMS spokesperson noted that 'while population differences exist across geographic areas, there is no indication these differences would impact the donor potential resulting in a disadvantage to one OPO compared with other OPOs.' Approaching Decertification In 2026, Tier 3 OPOs can appeal their decertification. Their contracts will remain in effect through January 31, 2027, 'to allow time for appeals and prevent disruption to organ donation services,' the CMS spokesperson said. But disruption is unavoidable, said Trageser. 'Decertification will lead to chaos and fewer organs available for transplant,' he said. Incoming OPO leadership would spend valuable time managing the logistics of taking over a service area instead of on 'their core mission of working with families in a time of crisis to advocate for donation and then getting those organs allocated.' Staff departures at decertified OPOs could further erode relationships with transplant hospitals, said AOPO CEO Steve Miller. Tier 1 OPOs Eye Expansion Matthew Wadsworth, president and CEO of Life Connection of Ohio (Tier 1), supports CMS' review process. While taking over of a service area would involve 'a lot of work,' donation would improve quickly and sharply under new leadership, he said, adding that there would be no chaos. Wadsworth is preparing to bid on at least one Tier 3 service area. Expansion, he said, would create economies of scale for his smaller OPO and reduce its operating costs. 'We've even gone through the financial modeling of it and had conversations with our bank,' he said. However, details about the decertification process remain unclear, including whether incoming OPOs would inherit assets from outgoing OPOs. The lack of clarity 'puts us in a tight situation,' said Wadsworth, because he needs to talk with his board of directors now about additional resources and staffing. CMS said only that decertification guidance will be released sometime before next spring's performance assessment.
