When Are You Dead?

Australian Cardiac Victims Can Donate Organs

Australian Cardiac Victims Can Donate Organs

Are you afraid that doctors will declare that you’re dead when you’re still alive but not responsive? The fear of being buried alive is a long-standing one, but these days folks might fear being tagged for organ or total body donation when they are, in fact, still alive. Have you ever thought about what measure is used to determine when people really are dead?

In the past, the fear of being buried alive was so widespread that special coffins were devised with life-saving devices. Edgar Allen Poe wrote about these premature burial fears in 1844 and as late as 1896, the Association for the Prevention of Premature Burials was founded. But, these premature burial fears were founded in the practice of burying a body as soon as possible after death.

Few if any premature burials are noted today, but with the rising interest in organ and full-body donations, some people might fear being cut open for research or donation purposes before they are fully deceased. On the other hand, many donors may not be able to donate organs, especially if they die of cardiac failure or disease.

Currently in Australia, the most common form of organ donation occurs among brain-dead patients, because cardiac deaths take too long to diagnose. In a recent news item, the Australian and New Zeland Intensive Care Society has called for new international standards on diagnosing death so organ donations can be boosted from cardiac deaths. The problem with organ donations is that the organs must be obtained as soon as possible after death. With brain death, which does not require a rapid diagnosis because a brain-dead person can be maintained on artificial life support until the donation operation, the timing is not crucial. But, a cardiac death is different, as diagnosis must be made quickly so the organs can be harvested before they become damaged from lack of circulation.

In Australia, cardiac death is declared when someone stops moving, breathing and lacks a pulse for two minutes or more. But, doctors want to extend this diagnosis to include two minutes after circulation ceases to ensure the heart won’t start again on its own. Death would be declared after circulation ceases, even if the brain shows signs of activity. This new way to diagnose deaths among cardiac victims also can reassure both practitioners and the public that donors after death truly are dead.

This diagnosis would be most valuable in cases where the patient does not want to be resuscitated. If doctors can wait two minutes after circulation ceases in a patient that is immobile, without pulse and not breathing, then the organ donation surgery can begin immediately without undue harm to the donated organs. And, patients and their families can rest assured that the patient truly is dead.

Australia and New Zealand hope to adopt this new policy by September 2009.

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