The circulatory–respiratory determination of death in organ donation*

  title={The circulatory–respiratory determination of death in organ donation*},
  author={James L. Bernat and Alexander M Capron and Thomas P Bleck and Sandralee A. Blosser and Susan L Bratton and James F. Childress and Michael A. Devita and Gerard J. Fulda and Cynthia J. Gries and Mudit Mathur and Thomas A. Nakagawa and Cynda H. Rushton and Sam D. Shemie and Douglas B White},
  journal={Critical Care Medicine},
Objective:Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory–respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory–respiratory death determination. We studied circulatory–respiratory death determination to clarify its concept, practice, and application to innovative circulatory determination of death protocols… 

An analysis of heart donation after circulatory determination of death

Only the Australia heart DCDD programme using a stand-off period of 5 min respects the dead donor rule (DDR) when the criteria of death are based on permanency.

Circulatory death determination in uncontrolled organ donors: a panel viewpoint.

Conceptual Issues in DCDD Donor Death Determination.

  • J. Bernat
  • Medicine
    The Hastings Center report
  • 2018
Making two related distinctions clarifies the cause of the disagreement over whether the DCDD donor is dead and points to a possible resolution.

The Debate over Death Determination in DCD

  • J. Bernat
  • Medicine
    The Hastings Center report
  • 2010
This issue, Don Marquis concludes that DCD donors are indeed not dead at the moment of donation because the cessation of their cardiac function is not irreversible, and DCD survives Marquis's criticisms.

Heart donation without the dead donor rule.

  • F. Miller
  • Medicine
    The Annals of thoracic surgery
  • 2014

Ethical Controversies in Organ Donation After Circulatory Death

Control DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria, and there are potential conflicts between the donor's and recipient’s interests.

Determination of death in donation after circulatory death: an ethical propriety

The Papworth technique for heart DCD does not compromise the permanence standard for declaring death and therefore respects the dead donor rule in the UK, but perhaps elsewhere the law would need to change to refer to the cessation of circulation in the brain.

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

The permanent cessation of circulation to the brain is established as the standard to determine death by circulatory criteria and the value of perfusion repair for increasing the success of cDCDD organ transplantation is highlighted.

Uncontrolled donation after circulatory death: ethics of implementation.

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

Seeking to reconcile end-of-life organ procurement for transplantation with the uniform determination of death act.

Bernat et al (1) reassure the general public that procuring organs in nonheartbeating donation is after death by novel reinterpretation of uniform determination of death act statutory language, and redefine the understanding of “permanence” and “irreversibility".



Role of brain death and the dead-donor rule in the ethics of organ transplantation

It is proposed that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donateTheir organs, without first being declared dead.

The boundaries of organ donation after circulatory death.

  • J. Bernat
  • Medicine
    The New England journal of medicine
  • 2008
A video roundtable discussion addresses key ethical aspects of organ donation after cardiac death, and what duration of asystole proves irreversibility.

Observations of withdrawal of life-sustaining treatment from patients who became non-heart-beating organ donors

It is suggested that 2 mins of absent circulation is sufficient to certify death, suggesting that non-heart-beating organ donation is increasing despite the concern whether all the donors are dead.

The death watch: certifying death using cardiac criteria.

  • M. Devita
  • Medicine
    Progress in transplantation
  • 2001
This article concludes with a rejection of a fixed notion of "irreversibility" because it does not conform to current practice, is potentially deleterious to social events at the time of death, and the reversibility of cardiopulmonary arrest is dependent on available means of resuscitation.

The dead donor rule.

  • J. Robertson
  • Medicine, Political Science
    The Hastings Center report
  • 1999
Proposals to permit donation from anencephalic infants or condemned prisoners aim to maintain respect for the core values underlying the dead donor rule while concluding that the benefits of relaxing the rule in these marginal cases outweigh the loss in respect for life and trust in the transplant system that might result.

Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement

This book examines transplantation supply and demand, historical and modern conceptions of non-heart-beating donors, and organ procurement organizations and transplant program policies, and contains recommendations concerning the principles and ethical issues surrounding the topic.

Extracorporeal support for organ donation after cardiac death effectively expands the donor pool.

The implementation of a DCD protocol using extracorporeal perfusion increased the potential organ donor pool at this institution by 33% and was accomplished without short term adverse effect on organ function compared with kidneys transplanted from DBD donors.

Donation after cardiocirculatory death in Canada

It is recommended that programs begin with controlled DCD within the intensive care unit where (after a consensual decision to withdraw life-sustaining therapy) death is anticipated, but has not yet occurred, and unhurried consent discussions can be held.

Doubts about Death: The Silence of the Institute of Medicine

  • J. Menikoff
  • Medicine
    Journal of Law, Medicine & Ethics
  • 1998
Organ retrieval from cadavers has taken place only in cases where the declaration of death has occurred using “brain death” criteria, and attention has been directed at the use of so-called “non-heart-beating” donors (NHBDs): individuals who are declared dead not as a result of direct measurements of brain function, but rather as a resulting of the cessation of heart and respiratory functions.

National recommendations for donation after cardiocirculatory death in Canada: Donation after cardiocirculatory death in Canada.

It is recommended that programs begin with controlled DCD within the intensive care unit where (after a consensual decision to withdraw life-sustaining therapy) death is anticipated, but has not yet occurred, and unhurried consent discussions can be held.