The thin flat line: redefining who is legally dead in organ donation after cardiac death

The debate over whether donation after cardiac death (DCD) donors are truly dead is not new but has surfaced mostly in the academic community. In 2008, widespread publicity was given to the indictment of a transplant surgeon in California in connectionwith the alleged administration of excessive and inappropriate medications to a potential donor awaiting cardiac death after removal from a ventilator. This and other reports in the lay press mirror the expanding use of DCD to boost the supply of organs. This article explains the practice of donation after cardiac death, examines whether DCD donors are legally dead under the UDDA, explores whether it is appropriate to apply DCD as it is currently practiced, addresses the concern that DCD is causing the death of donors, and suggests several approaches to resolve the controversy over the determination of death in DCD donors. The author concludes with a call for this debate to move beyond scholarly journals into the public arena.