Whose consent matters? Controlled donation after cardiac death and premortem organ-preserving measures

The goal of this overview is to discuss the ethics of premortem organ-protective measures with the aim of improving donation outcome for the recipient. A literature review was undertaken to find out which such measures were implemented in published articles on controlled donation after cardiac death. We reviewed studies on controlled human organ donation after cardiac death that were published in PUBMED and EMBASE between 2000 and 2010. To fit the inclusion criteria, studies had to describe the procedures that took place before the donor's death. We found 35 studies that were undertaken in six countries. Twenty-one of these studies mentioned the use of premortem measures on the donor that had the aim to improve the outcome of donation for the recipient. These measures illustrated a wide spectrum of invasiveness. The authors conclude that premortem measures have the potential to instrumentalize the organ donor and that they should be restricted to cases in which the donor wish is known-directly, through a donor card, or through a surrogate decision maker-and specific consent to premortem procedures has been given. This specific consent should be required at least until the general public is aware that premortem measures may be performed. If potential donors were informed about premortem measures as part of a community information effort, for example, school curricula, and again when they signed their donor card, one might consider their consent to be truly informed and valid.