Enabling Donation after Cardiac Death in the Emergency Department: Overcoming Clinical, Legal, and Ethical Concerns

Dailey, Michael W.; Geary, Sean P.; Merrill, Stefan; Eijkholt, Marleen

doi:10.1016/j.jemermed.2016.11.025

Cited by 5 publications

(1 citation statement)

References 10 publications

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“…The definition of human death is based on the permanent loss of capacity for consciousness and all brain stem functions, which may occur either as a result of catastrophic brain injury or as a consequence of the permanent loss of circulation [33]. Although the definition of death by neurological criteria has been widely accepted and incorporated into legislation of a large number of countries, this has not been the case for death based on circulatory criteria [11,20 && ,21 & , [34][35][36]. In countries where cDCD is common, there is broad consensus that death should be based on the 'permanent' cessation of circulation -a point where circulation will not be either spontaneously or artificially restored [37].…”

Section: Andandmentioning

confidence: 99%

Uncontrolled donation after circulatory death: ethics of implementation

Molina

Domínguez‐Gil

Pérez-Villares

et al. 2019

Current Opinion in Organ Transplantation

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Purpose of review Despite its potential to increase the donor pool, uncontrolled donation after circulatory death (uDCD) is available in a limited number of countries. Ethical concerns may preclude the expansion of this program. This article addresses the ethical concerns that arise in the implementation of uDCD. Recent findingsThe first ethical concern is that associated with the determination of an irreversible cardiac arrest. Professionals must strictly adhere to local protocols and international standards on advanced cardiopulmonary resuscitation, independent of their participation in an uDCD program. Cardiac compression and mechanical ventilation are extended beyond futility during the transportation of potential uDCD donors to the hospital with the sole purpose of preserving organs. Importantly, potential donors remain monitored while being transferred to the hospital, which allows the identification of any return of spontaneous circulation. Moreover, this procedure allows the determination of death to be undertaken in the hospital by an independent health care provider who reassesses that no other therapeutic interventions are indicated and observes a period of the complete absence of circulation and respiration. Extracorporeal-assisted cardiopulmonary resuscitation programs can successfully coexist with uDCD programs. The use of normothermic regional perfusion with ECMO devices for the in-situ preservation of organs is considered appropriate in a setting in which the brain is subject to profound and prolonged ischemic damage. Finally, communication with relatives must be transparent and accurate, and the information should be provided respecting the time imposed by the family's needs and emotions. Summary uDCD can help increase the availability of organs for transplantation while giving more patients the opportunity to donate organs after death. The procedures should be designed to confront the ethical challenges that this practice poses and respect the values of all those involved.

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