Is it time to revisit elective ventilation?

Elective ventilation is in simple terms the process of keeping a person alive through artificial ventilatory support for the purpose of procuring organs. The Exeter Protocol famously used elective ventilation as a means of maintaining physiology of patients who were imminently expected to die from intracranial haemorrhage to facilitate organ donation. The original paper was published in the Lancet in 1990. This paper provoked a storm of protest which culminated in a legal challenge to the notion of elective ventilation. This legal challenge was supported and elective ventilation became unlawful in the UK.

Fast forward 15 or 20 years and the social and legal landscape has changed somewhat. We now have a Human Tissue Act (England and Wales 2004) and Scotland (2006) which recognises and gives greater priority to the choices and wishes of an individual in life to determine whether their organs should be donated for transplantation after death. There is a political will, stated in the Organ Donor Task force report commissioned by the Government, to make organ donation part of the norm rather than an exceptional or extraordinary event. We also have pressure from many (non-medical) sectors of the public to pass a law of presumed consent.

The landscape has probably now changed sufficiently to warrant a re-consideration of the process of supporting a patient who is dying to enable them to donate their organs. “Elective ventilation” is now considered a dirty word and may not be the best term to describe intensive care support of the irretrievable patient who has stated in life that they wish to donate their organs if the circumstances of their death should so permit. It already happens in many countries where intensive care is better resourced (the UK has one of the lowest rates or provision of ventilated beds in relation to population in the Western World).

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This figure was published originally in the Daily Mail newspaper

John Coggan from Southampton University presents an excellent and balanced consideration of some of the key issues around this subject in his article “Elective ventilation for organ donation: law, policy and public ethics.” in the Journal of Medical Ethics. If you have an interest in organ donation or elective ventilation I would urge you to read this article and form your own opinion.

As a potential stakeholder I would be considered to have a conflict of interest and so will keep my own opinion to myself.

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