An analysis of heart donation after circulatory determination of death

Area of Science:

• Medical Ethics
• Cardiovascular Surgery
• Organ Transplantation

Background:

• Ethical debates surround heart donation after circulatory determination of death (DCDD).
• Key concerns involve the donor's death status at declaration and organ procurement.
• The dead donor rule (DDR) is central to these ethical discussions.

Purpose of the Study:

• To rigorously analyze four heart DCDD programs (Cape Town, Denver, Australia, Cambridge).
• To assess program compliance with the dead donor rule (DDR).
• To evaluate adherence based on six distinct criteria of death.

Main Methods:

• Analysis of four international heart DCDD programs.
• Assessment against six criteria of death: irreversible cessation of all bodily cells function, irreversible cessation of heart function, irreversible cessation of circulation, permanent cessation of circulation, irreversible cessation of brain function, and permanent cessation of brain function.
• Evaluation of adherence to the dead donor rule (DDR).

Main Results:

• Only death criteria based on permanency are compatible with the DDR.
• Two conditions are necessary: a minimum 5-minute stand-off period and no interventions to resume circulation.
• The Australian heart DCDD program, with a 5-minute stand-off, respects the DDR based on permanent cessation criteria.

Conclusions:

• Permanent cessation criteria, coupled with a 5-minute stand-off period and no circulatory support, align with the DDR.
• The Australian DCDD program is the only analyzed program that respects the DDR under these conditions.
• Ensuring donor death is permanent is crucial for ethical heart DCDD.