Controlled non-heart beating organ donation: neither the whole solution nor a step too far.

While many intensive care clinicians in the UK continue to express significant concerns regarding controlled non-heart beating organ donation, others are involved in established programmes that make an increasingly significant contribution to the total number of cadaveric donations each year. The successful introduction of a controlled non-heart beating organ donation programme requires local resolution of any apparent ethicolegal obstacles to the process, with specific attention needing to be given to three areas: the potential conflict of interest between decision making over futility and any subsequent approach regarding organ donation; a belief that it may be unlawful to adjust in any way an end of life care pathway in order to allow donation to take place, and, finally, an uncertainty over how soon after cardiac death organ retrieval can begin. It is proposed that recent changes in legislation provide, through an emphasis on patient autonomy and best interests, a solid ethicolegal foundation for donation after cardiac death.