Transplantation of the heart after circulatory death of the donor: time for a change in law?

Procurement of organs has always been conducted according to the dead donor rule, that is, after death of the donor — but this practice is being challenged. Introduction Australia has an increasing shortfall in transplantable hearts. Over the past decade, the number of all donors per million population increased from 10.0 in 2005 to 16.1 in 2014. However, the number of heart donations per million population over the same period has declined slightly from 3.8 to 3.4, with an annual average of 3.3. Procurement of organs has always been conducted according to the dead donor rule — that is, after death of the donor — but this practice is being challenged. The law defines death in all Australian jurisdictions (eg, in s 41 of the Human Tissue Act 1982 [Vic]) as either “irreversible cessation of all functions of the brain” (brain death) or as “irreversible cessation of circulation of blood in the body” (circulatory death), but it does not define irreversible or how to determine irreversibility. Exceptionally, circulatory death is not defined in Western Australian legislation. Although the procurement of organs such as livers, kidneys and lungs is permitted after either brain death or circulatory death according to Acts in all jurisdictions, the procurement of hearts has traditionally only been from brain dead donors with functioning hearts. The definition and diagnosis of brain death is not without controversy and may explain in part why more reliance is being placed on circulatory death, which reduces availability of hearts. Alternatively, organ procurement from patients after circulatory death may be perceived as more realisable than after brain death. Indeed, circulatory death as the source of solid organs has increased from 10% of 204 donors in 2005 to 28% of 378 donors in 2014. More total organs have been procured (from 726 to 1193) but the number of hearts has increased only slightly from 72 of 204 donors (35%) to 79 of 378 donors (21%) over the same period. Only 39 hearts were procured from 189 donors (21%) during the first 6 months of 2015

Medico-legal decision making for incapacitated neonates

This thesis finds there is a need for greater transparency and objectivity in end-of-life decision making for extremely premature and critically ill infants. To achieve this objectivity, the allocation of finite public healthcare resources, and corresponding quality of life, should be a principal consideration in treatment decisions