An Official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: Ethical and Policy Considerations in Organ Donation after Circulatory Determination of Death

Abstract

The information presented in this Statement is based on the current evidence, experience, and clinical rationale. New clinical research and the development and dissemination of new technologies will eventually necessitate an update of this Statement.

Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death

“…In the Netherlands, premortem cannulation for ISP is allowed (3,15). The American Thoracic Society views premortem cannulation as ethically acceptable if "it contributes to good transplant outcomes" and if informed consent is obtained from the patient or the next of kin (6). In Canada, premortem cannulation is authorized with informed consent from the patient or the next of kin (5).…”

“…These include premortem insertion of cannulas (ECMO and a deflated aortic occlusion balloon or ISP) (6,11). When postmortem interventions are as invasive as ECMO, we reject the assumption "that a self-declared donor will accept the view that preservation is ancillary to the donation procedure itself and is implied and authorized by his or her consent" (3).…”

Update in Lung Transplantation 2013

“…In response to the need for increased organ availability for all potential recipients, the American Thoracic Society Health Policy Committee released a joint statement with the International Society for Heart and Lung Transplantation, Society of Critical Care Medicine, United Network for Organ Sharing (UNOS), and the Association of Organ Procurement Organizations considering matters of ethics and policy related to controlled DCDD (6). The statement places emphasis on high-quality palliative care for dying patients, early Association of Organ Procurement Organizations notification, thorough conversations with surrogates regarding expectations, and effective collaboration among skilled personnel to derive a plan that will best support viable organ donation and alleviation of suffering (6).…”

“…The statement places emphasis on high-quality palliative care for dying patients, early Association of Organ Procurement Organizations notification, thorough conversations with surrogates regarding expectations, and effective collaboration among skilled personnel to derive a plan that will best support viable organ donation and alleviation of suffering (6).…”

The Role of Patient Comfort and “Comfort Measures Only” in Organ Donation after Cardiac Death (DCD) After a Stroke

“…According to the American Thoracic Society position paper on DCD, "Ante mortem interventions are ethically appropriate if they contribute to a good transplant and have a low chance of harming the prospective donor" (Gries et al 2013). The question is, who defines and who decides these interventions?…”