Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed...

Area of Science:

• Medical Ethics
• Organ Donation
• Cardiocirculatory Death

Background:

• Donation after cardiocirculatory death (DCD) is a practice where organs are procured after circulatory and respiratory function have irreversibly ceased.
• While widely accepted, ethical concerns regarding the definition of death and potential conflicts of interest persist.
• The dead donor rule, which stipulates that organ procurement must not cause the donor's death, is central to the ethical debate.

Purpose of the Study:

• To critically evaluate the ethical permissibility of DCD, challenging the notion that its ethical issues are resolved.
• To argue that DCD may violate the dead donor rule because donors may not be definitively dead at the time of organ procurement.
• To advocate for a moratorium on DCD until ethical concerns are fully addressed and debated publicly.

Main Methods:

• Review and analysis of the DCD process and its standard ethical justifications.
• Examination of specific ethical concerns: irreversibility of circulatory arrest, conflicts of interest, premortem interventions, legal and medical standard claims, and quality of consensus statements.
• Critique of common arguments favoring DCD, such as the benefits of organ donation.

Main Results:

• The irreversibility of absent circulation in DCD donors has not been conclusively established.
• Unavoidable conflicts of interest exist at all stages of the DCD process, from life support withdrawal to organ procurement.
• Premortem interventions aimed at preserving organ viability may be ethically unjustifiable and could hasten death.

Conclusions:

• DCD is ethically problematic as it may violate the dead donor rule, involves unavoidable conflicts of interest, and employs potentially harmful premortem interventions.
• Current claims of legal and medical standard conformity are misleading; consensus statements are often of low quality and influenced by conflicts of interest.
• Full public disclosure of these ethical issues and open debate are necessary before DCD can be considered ethically permissible; a moratorium is called for in the interim.