A recent study on the effects of "auto-resuscitation" may influence national standards for organ removal, according to James Bernat, a professor of neurology and medicine at Dartmouth Medical School. Bernat is currently working with a group of scientists to develop national guidelines for the length of time doctors must wait to determine death before a patients' organs can be removed for donation.
"Auto-resuscitation," or the unassisted return of circulation, can occur in certain situations after a patient's heart stops beating, according to the study cited by Bernat, which was conducted by a group of researchers from McGill University and published in the May issue of the medical journal Critical Care Medicine.
The possibility of auto-resuscitation affects the amount of time doctors must wait before removing organs for donation after a patient's heart has stopped beating.
Current guidelines for the circulatory determination of death in "control situations" require that a doctor wait two to five minutes after the patient's heart stops before the patient's organs can be removed, Bernat said in an interview with The Dartmouth.
"The problem with waiting a long time is that the organs start to decay," he said. "So although as a matter of public policy it might be desirable to wait longer, as a matter of organ health you want to wait shorter."
The McGill study found no examples in which auto-resuscitation restored circulation for patients in "control situations," which occur when a patient has been on life support and is taken off. In these cases, the removal of life-sustaining therapy causes a patient to die, and organs are removed immediately upon death, according to Bernat.
In an interview with The Dartmouth addressing the research, Bernat called it a "good study," saying that he thinks it will eventually have an impact on medical protocols by shortening the time doctors have to wait before pronouncing death in control situations.
Bernat stopped short of recommending a definite change in the guidelines, however.
"I don't think that it's a good idea to change practice overnight based on a single study," he said.
Most U.S. hospitals do not use donated organs in uncontrolled situations when patients die from cardiac arrest without having been on life support, according to the McGill study.
The most recent data shows that patients in uncontrolled situations those without life support have experienced successful auto-resuscitation that restores circulation up to seven minutes after the patient's pulse stopped, according to an editorial by Bernat printed in the New England Journal of Medicine.
If the United States were to allow for organ donation in uncontrolled situations, there would have to be a longer waiting period to ensure that there is no chance of auto-resuscitation, Bernat said. Guidelines for controlled versus uncontrolled situations vary among different countries, according to Bernat.
Bernat was the chair of a panel of researchers funded by the Heath Resources and Services Administration to study circulatory-respiratory death determination and develop protocols for doctors to follow. The group's research was published in Critical Care Medicine in March.
Bernat's group will look into developing more specific guidelines addressing uncontrolled circumstances in the United States if they receive more funding for their project, he said.
"That funding is pending right now," Bernat said.
