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A change in legislation could increase heart transplant numbers

A change in legislation could increase heart transplant numbers - Featured Image

More hearts could become available for transplant if key terms were altered in transplant legislation, experts say.

According to an Ethics and Law article published in the Medical Journal of Australia, the current legislation has resulted in only 39 hearts being procured from 189 donors (21%) during the first 6 months of 2015.

Associate Professor James Tibballs, Deputy Director of the Intensive Care Unit at Royal Children’s Hospital in Melbourne, and Dr Neera Bhatia, Lecturer at the Deakin University School of Law in Melbourne believe this could change.

They write in their article that the law defines death as either “irreversible cessation of all functions of the brain” (brain death) or “irreversible cessation of circulation of blood in the body” (circulatory death).

Related: Are potential organ donors missed on general wards? A 6-month audit of hospital deaths

Tibballs and Bhatia write that the problem is the legislation doesn’t define irreversible or how to determine irreversibility.

“The fact that a transplanted heart can function and sustain life in a recipient must mean that the circulation of the donor had never ceased irreversibly and therefore that the donor of the heart was never dead until his or her heart was removed.

“The question is thus posed — how is it possible to procure the heart of a donor under the premise of circulatory death and yet expect it to sustain life in a recipient?”

They say this legal grey area means a transplant surgeon could possibly be committing a criminal act by transplanting after circulatory death.

They have provided a possible alternative, being: “Retain the present definition of brain death as irreversible cessation of all function of the brain, but to omit the requirement for irreversibility in the definition of circulatory death and to redefine it as cessation of circulatory function with cessation of higher brain function”, they suggested.

They feel that with such an alteration could increase heart transplant numbers and improve outcomes for the organ donation program.

“Otherwise, Australia’s improving organ donor program is at risk of adverse publicity and damage if doctors, hospitals and our organ procurement agencies are perceived as procuring organs from patients not legally dead,” they write.

A podcast with Associate Professor Tibballs and Dr Bhatia is available at www.mja.com.au/multimedia/podcasts and iTunes. Also available as a video at www.mja.com.au/multimedia

Related: MJA article rejected by transplant experts

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