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Belgian modified classification of Maastricht for donors after circulatory death
P Evrard1,
1Intensive Care Unit, CHU Dinant Godinne, UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
Insights
A new classification system for donors after circulatory death (DCD) was developed by Belgian experts. This system simplifies categorizing DCD donors, aiding ethical considerations and public understanding in organ donation.
Area of Science:
- Transplantation Medicine
- Bioethics
- Public Health
Background:
- Donors after circulatory death (DCD), previously termed non-heart-beating donors, represent a significant potential source for organ donation.
- Expanding the organ donor pool is crucial to meet the growing demand for transplants.
Purpose of the Study:
- To propose a novel classification system for donors after circulatory death.
- To simplify the categorization of DCD donors for ethical and public understanding.
Main Methods:
- A consensus of experts from all Belgian transplant centers was convened.
- A new classification system was developed based on expert agreement.
Main Results:
- The classification is structured into five categories (I-V) based on the circumstances of circulatory arrest.
- Categories are divided into uncontrolled (I-II) and controlled (III-V) situations.
- Category V specifically addresses organ donation following euthanasia, permitted under Belgian law.
Conclusions:
- The proposed classification is simple, clear, and retains the structure of the Maastricht classification.
- It facilitates the ethical evaluation and understanding of different DCD donor types for both specialists and the general public.
- This clarity aims to foster public trust and consideration in the field of organ donation.
Background:
"Non-heart-beating donors," or, in a more recent and international definition, "donors after circulatory death," are a potential and additional group of deceased persons who are able to add organs to the pool.
Methods:
A new classification is proposed on the basis of the result of a consensus of experts issued from all Belgian transplant centers.
Results:
The first level of definition is simple and based on whether the situation is uncontrolled (categories I and II) or controlled (categories III, IV, and V). In category I, the patient is declared "dead on arrival" and, in category II, there is an "unsuccessful resuscitation" whether it occurred out or in the hospital for both situations. Category III is the most usual situation in which the treating physician and family are "awaiting cardiac arrest" to declare the death of the patient. Category IV is always characterized by "cardiac arrest during brain death." The special situation of the Belgian law allowing the euthanasia is elaborated in category V, "euthanasia," and includes patients who grant access to medically assisted circulatory death. Organ donation after euthanasia is allowed under the scope of donation after circulatory death.
Conclusions:
This classification conserves the skeleton of the Maastricht one, as it is simple and clear, but classifies easily the different donors after circulatory death types by processes for ethical issues and for the non-medical or non-specialized reader interested in the field. This is also an argument for public consideration and trust in the difficult field of organ donation.
