A. Imminent Death Donation (IDD) is a term to describe organ procurement from a live donor before withdrawal of ventilator support and/or from a patient with a terminal illness with capacity for medical-decision making, who wishes to donate and not accept further life support. This study aims to serve as a literature review of the ethical issues involved in imminent death donation, specifically as it pertains to the key points brought forth by the OPTN/UNOS Public Comment Proposal “Ethical Considerations of Imminent Death Donation”.

B. A review of published papers was performed based on a Medline search using the term “Imminent Death Donation” and 7 articles were identified broaching the topic of the ethics of IDD. These were reviewed and arguments for and against IDD were juxtaposed, highlighting the salient obstacles to implementing a procurement protocol that could allow for more organ recoveries with better allograft outcomes.

C. Consistently, the benefits of IDD are summarized as follows: 1) Honoring the preferences of the donor/donor family, allowing for the goal of organ donation to be achieved more often, 2) reliable organ recovery as opposed to failure to progress to asystole 3) less ischemic damage to organs 4) more compassionate end of life care and 5) arguably, increasing the number of organs for transplantation and/or the pool of eligible donors. However, as best summarized in the OPTN/UNOS Public Comment Proposal, the concerns over IDD thus far making it impractical for implementation include: 1) the lack of definitions and boundaries 2) no definitive data to prove that IDD would increase the number of organs and/or donors 3) with the potential to decrease the number of organs recovered 4) importantly, the potential to compromise public trust and opinion on organ donation, while increasing confusion on appropriate end-of-life care and 5) lack of stakeholder buy-in or assignment of roles and responsibilities.

D. Despite an agreement amongst multiple ethics committees, including that of the UNOS/OPTN Ethics committee, that IDD is a viable and ethical option for organ procurement, the Dead Donor Rule (DDR) remains a bedrock in the public and transplant psyche, that is, organ donation cannot lead to the death of the donor. In understanding the dueling arguments and biases of convention, perhaps it is time to address the need to expand our definitions of organ donors and the value, if any, of the DDR in our ever-evolving field.

CITATION INFORMATION: Galvan N., Geha J., Ackah R., Kueht M., Cotton R., O'Mahony C., Rana A., Goss J. The Ethical Turmoil of Imminent Death Donation Am J Transplant. 2017;17 (suppl 3).

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