Organ donation after circulatory death: the forgotten donor?

Area of Science:

• Medical Ethics
• Transplantation Surgery
• Organ Donation Policy

Background:

• Donation after Circulatory Death (DCD) involves donors without neurological or brain death criteria before arrest.
• Mandatory DCD implementation in the USA presents significant donor-related ethical controversies.
• Current practices raise questions about donor eligibility and the dead donor rule.

Purpose of the Study:

• To critically examine controversial issues surrounding mandatory DCD implementation in the USA.
• To evaluate the scientific basis and ethical implications of the dead donor rule in DCD.
• To assess the impact of DCD on end-of-life care and informed consent.

Main Methods:

• Non-structured review of selected publications and websites.
• Data extraction and synthesis of existing literature and policy information.
• Analysis of scientific evidence regarding circulatory arrest and organ procurement.

Main Results:

• The 5-minute circulatory arrest criterion may not consistently satisfy the dead donor rule for neurologically intact donors.
• Extracorporeal perfusion evidence suggests procurement may cause irreversibility in DCD.
• Organ procurement organization involvement in consent may create conflicts of interest and bias.

Conclusions:

• Legislative reform of the dead donor rule is needed due to the lack of scientific foundation for current DCD practices.
• Reforming consent processes is crucial to ensure genuine informed consent and avoid conflicts of interest.
• The impact of DCD on the quality of end-of-life care and achieving a 'good death' requires further satisfactory attention.