ABA Family Legal Guide

Health-Care Law

Specific Issues in Health Care

Organ Donation

What is non-heart-beating donation?

Non-heart-beating donation (NHBD) comprises about 2 percent of all organ donations, but is expected to increase in the future. It occurs when the patient is not brain dead, but is on a ventilator and is in a vegetative state or considered "hopeless," and the family consents to having the ventilator withdrawn. When the ventilator is removed, doctors wait for the patient's heart and breathing to stop, declare cardiac death either immediately or after a waiting period of a few minutes, and then harvest the organs in an operating room.

If, as sometimes happens, the potential NHBD patient does not stop breathing when the ventilator is removed and continues to have a heartbeat, doctors usually wait an hour before canceling the harvest. Since the decision to withdraw treatment already has been made, if the patient continues breathing, he or she is returned to the hospital room to die without treatment being resumed.

There are serious ethical concerns about NHBD. Although supporters of NHBD insist that the withdrawal of ventilators is legally and ethically allowable because such patients are hopeless, these decisions are sometimes made because of potential quality-of-life concerns rather than the patient's ability to survive. Critics claim that the pressure to find and harvest suitable organs is robbing some severely injured people of a chance to recover. Issues arising in the assisted suicide debate are also relevant here, with disability advocates concerned that the increase in NHBD will place growing pressure on disabled people who are dependent on life support to "pull the plug" to enable them to donate organs.