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Updated: Mar 24, 2026
A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
Is heart transplantation after circulatory death compatible with the dead donor rule?
Michael Nair-Collins1, Franklin G Miller2
1Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida, USA.
Insights
The dead donor rule (DDR) is incompatible with donation after circulatory death (DCD) protocols. Researchers argue for abandoning the DDR, rather than creating flawed criteria to justify DCD.
Area of Science:
- Bioethics
- Transplantation Medicine
- Medical Law
Background:
- Dalle Ave et al. (2016) reviewed heart transplantation protocols following circulatory death.
- Their analysis examined the compatibility of donation after circulatory death (DCD) with the dead donor rule (DDR).
Discussion:
- The study critiques Dalle Ave et al.'s (2016) flawed analysis of DCD and DDR compatibility.
- Their proposed permanence-based criteria for death are deemed ad hoc, legally and ethically unfounded.
- The analysis undermines the DDR's purpose, rendering it trivial.
Key Insights:
- Existing legal and bioethical frameworks struggle to reconcile DCD with the DDR.
- The DDR's integrity is compromised by attempts to adapt it for DCD.
- New criteria for death are unnecessary and problematic.
Outlook:
- Explicitly abandoning the DDR is proposed as the most straightforward approach.
- This allows for the ethical and legal advancement of DCD protocols.
- Future research should focus on establishing clear guidelines for DCD independent of the DDR.
Abstract:
Dalle Ave et al (2016) provide a valuable overview of several protocols for heart transplantation after circulatory death. However, their analysis of the compatibility of heart donation after circulatory death (DCD) with the dead donor rule (DDR) is flawed. Their permanence-based criteria for death, which depart substantially from established law and bioethics, are ad hoc and unfounded. Furthermore, their analysis is self-defeating, because it undercuts the central motivation for DDR as both a legal and a moral constraint, rendering the DDR vacuous and trivial. Rather than devise new and ad hoc criteria for death for the purpose of rendering DCD nominally consistent with DDR, we contend that the best approach is to explicitly abandon DDR.
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