The ethics of donation after circulatory death organ recovery: an overview of new considerations arising from procurement practice and policy changes

Abstract

Purpose of reviewThe aim of this study is to examine ethical issues raised by organ recovery from donors after circulatory death (DCD). Recent findingsRecent technological developments and policy modifications have implications for evolving ethical issues related to DCD organ procurement and donation. We identify four such changes and discuss the most significant ethical issues raised by each: the use of cardiac perfusion machines and the need to develop criteria to allow prioritization for organ preservation in joint thoracic-abdominal procurements, normothermic regional perfusion and the irreversibility criterion in the definition of death, practice variability in DCD withdrawal of care and death declarations, and equitable access to donation, and changes in organ procurement organization evaluation metrics and transplant system resource utilization.

Dilemmas concerning heart procurement in controlled donation after circulatory death

“…This approach places emphasis on the central role of the brain in distinguishing life from death. Taking this into account, this approach suggests that mechanical restoration of circulation (TA-NRP) to other organs than the brain would be feasible as long as restoration of blood flow to the brain would be prevented ( 13 , 14 , 47 , 50 ). This is the basis on which TA-NRP is introduced in the United Kingdom, Belgium and in the United States ( 39 , 51 ).…”

“…This ongoing debate over TA-NRP seems to originate from different interpretations of the concept of circulatory death, the interpretation of mechanical resumption of circulation in light of the dead donor rule (DDR), and the differences in length of the "no-touch" period (11). For instance, some approach circulatory cessation in the setting of cDCD as the defining moment at which the process of brain mortification ensues, as brain perfusion is absent from that moment onwards (12)(13)(14)(15). This implies that as long as the process of brain mortification is not disturbed, mechanical resumption of circulation is in accordance with circulatory death and places emphasis on the central role of the brain in distinguishing life from death.…”