Case 2: Organ Donation in an Unidentified Patient

Case 2: Organ Donation in an Unidentified Patient

Case 2: Organ Donation in an Unidentified Patient

An elderly black female was found slumped over a bench at a bus station in New Jersey and paramedics were called. She was found to have cardiac rhythm abnormalities and was immediately transferred to the local hospital emergency department (ED). In the ED, she was found to have profound neurologic deficits and two large areas of ischemic stroke, with associated brain edema on CT scan. She was subsequently placed on a ventilator, and immediately transferred from the local hospital to the area’s tertiary medical center intensive care unit (ICU) for further management. Attempts were made to identify the patient with police assistance, without success. In the tertiary care hospital, a repeat scan of the brain noted extension of the stroke with poor prognostic indicators, including additional areas of damage and worsening brain edema causing a high potential for brainstem herniation. The patient remained unidentified in the ICU and area police were called who performed fingerprint analysis and entered her picture into facial recognition software. No return identification was made despite aggressive measures. The patient was noted to decline clinically with loss of further neurologic responses. A bioethics consultation was called for consideration of de-escalation of aggressive measures in the setting of a very poor prognosis. The patient subsequently began to decline rapidly and she was declared brain dead by radiographic and clinical criteria in accordance with hospital policy. Also in accordance with hospital policy, the patient’s death was reported to the organ donation organization associated with the institution. The organ donation organization personnel informed the ICU staff that an unidentified person who is declared brain dead was directed toward organ donation. Further, the hospital administrator was informed that she was obliged to sign the consent providing there was no evidence that the patient would not want organ harvesting.

1. Should the unidentified female’s organs be donated (should her consent be assumed)? Please explain your reasoning.