Transparency and accountability in mass media campaigns about organ donation: a response to Morgan and Feeley.

We respond to Morgan and Feeley's critique on our article "Mass Media in Organ Donation: Managing Conflicting Messages and Interests." We noted that Morgan and Feeley agree with the position that the primary aims of media campaigns are: "to educate the general public about organ donation process" and "help individuals make informed decisions" about organ donation. For those reasons, the educational messages in media campaigns should not be restricted to "information from pilot work or focus groups" but should include evidence-based facts resulting from a comprehensive literature research.

Mass media campaigns and organ donation: managing conflicting messages and interests.

Mass media campaigns are widely and successfully used to change health decisions and behaviors for better or for worse in society. In the United States, media campaigns have been launched at local offices of the states' department of motor vehicles to promote citizens' willingness to organ donation and donor registration. We analyze interventional studies of multimedia communication campaigns to encourage organ-donor registration at local offices of states' department of motor vehicles.

Scientific, legal, and ethical challenges of end-of-life organ procurement in emergency medicine.

Aim: We review (1) scientific evidence questioning the validity of declaring death and procuring organs in heart-beating (i.e., neurological standard of death) and non-heart-beating (i.

Presumed consent for organ preservation in uncontrolled donation after cardiac death in the United States: a public policy with serious consequences.

Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for duration before stopping resuscitation efforts and techniques, and assumption of presumed intent to donate for the purpose of initiating temporary organ-preservation interventions when no expressed consent to donate is present.

Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation.

In 1968, the Harvard criteria equated irreversible coma and apnea (i.e., brain death) with human death and later, the Uniform Determination of Death Act was enacted permitting organ procurement from heart-beating donors.

Enforcement of presumed-consent policy and willingness to donate organs as identified in the European Union Survey: the role of legislation in reinforcing ideology in pluralistic societies.

To increase the supply of transplantable organs, some European Union (EU) countries have begun implementing and enforcing presumed consent policies for organ donation. Mossialos and colleagues performed an analysis of samples of citizens in 15 EU countries and found that legislation, enforcement, and awareness of presumed consent policies for organ donation increase people's willingness to donate their own organs and those of a deceased relative. The authors concluded that, in countries with enforced presumed consent, citizens are willing to donate because they accept organ donation as an ideology.

Ethical challenges with the left ventricular assist device as a destination therapy.

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy raises certain ethical challenges.

Do donation after cardiac death protocols violate criminal homicide statutes?

It is widely known that there is a tremendous shortage of organs for transplantation. In an attempt to increase the number of organ donations, the Institute of Medicine (IOM) in its 1997 and 2000 reports and United States Department of Health and Human Services, recommended the promotion of programs for Donation after Cardiac Death (DCD). DCD involves the withdrawal of life support from the patient/donor.

Organ procurement after cardiocirculatory death: a critical analysis.

To shorten the transplantation waiting time in the United States, federal regulations have been introduced requiring hospitals to develop policies for organ donation after cardiac (or circulatory) death (DCD). The practice of DCD is invoked based on the validity of the University of Pittsburgh Medical Center (UPMC) protocol and relies on the accuracy of the University of Wisconsin (UW) evaluation tool to appropriately identify organ donors. There is little evidence to support the position that the criteria for organ procurement adopted from the UPMC protocol complies with the dead donor rule.