The objective of this case report is to explore the ethical considerations of bolus dose heparin for organ procurement after cardiac death in a patient with intracerebral hemorrhage (ICH).

A 65 -year-old man presented to the hospital with a headache followed by altered mental status. He was found to have a large right temporoparietal lobar ICH. The patient was intubated and admitted to the Neuro-ICU. On examination he was comatose and had no brainstem reflexes or response to stimuli. Following a discussion with the family, and in accordance with the patient’s wishes, he was to undergo organ donation after cardiac death (DCD). The family did not want to wait for progression to brain death. Per hospital DCD policy, to improve organ viability the patient was to receive 30,000 units of heparin prior to cardiac death. The primary team was concerned that heparin administration might lead to expansion of the ICH hastening death therefore violating the principle of non-maleficence.

This case brought to light the interplay between the ethical principles of autonomy, justice, and non-maleficence as it relates to DCD.  Exploration of cases in the literature and protocols from peer institutions highlight that there is not agreement on this issue.

Non-maleficence was ultimately determined to be the driving principle which resulted in the heparin bolus not being given.  With collaboration with the organ procurement organization, an alternative protocol was followed and the patient was able to donate his kidneys.