Ethical implications of extracorporeal interval support for organ retrieval (EISOR)

With a growing demand for whole organs for transplantation, non-heart-beating organ donation is being revisited as a method of organ procurement. Extracorporeal interval support for organ retrieval (EISOR) is a new method to improve organ viability in non-heart-beating organ donation, but it potentially introduces ethical consequences.Our methodology included literature searches (Medline, Ovid, and bibliographies), abstract reviews, meeting presentations, and interviews with leaders in the field of organ donation and EISOR. No published articles on EISOR were found. Of the people interviewed (three EISOR enthusiasts, a medical ethicist, a Jewish rabbi, and a Catholic theologian), most agreed that premortem administration of systemic heparin was acceptable. Those who dissented stated that the potential of heparin to hasten a donor's death was unacceptable. All except one undecided person consented that the prevention of reanimation of the heart postmortem is an acceptable practice. With the advent of EISOR, the ethical issues surrounding the practice of premortem interventions and medications require more discussion among physicians, medical staff, and ethicists. Specifically, the dignity of death and premortem and postmortem interventions are discussed in this paper.