Organ donation and imminent death: pro position

Area of Science:

• Transplantation Medicine
• Bioethics
• Organ Donation Policy

Background:

• Donation after cardiac death (DCD) faces challenges like ischemic injury and delayed allograft function.
• Imminent death donation (IDD) is proposed as a distinct category, separate from living donation and DCD.

Purpose of the Study:

• To review the ethical considerations and potential benefits of imminent death donation (IDD).
• To advocate for the continued exploration and implementation of IDD strategies.

Main Methods:

• Review of an established IDD protocol from Rhode Island Hospital.
• Analysis of reviews and statements from the United Network for Organ Sharing (UNOS) Ethics Committee and working groups.

Main Results:

• An IDD protocol was developed and deemed ethically appropriate in some cases by the UNOS Ethics Committee.
• UNOS working groups supported IDD but noted policy revision needs and concerns about public trust.
• IDD and similar strategies are being discussed, proposed, and implemented internationally.

Conclusions:

• The medical community should continue efforts to implement imminent death donation (IDD).
• IDD can align donor family wishes with successful organ transplantation and dignified end-of-life care.
• In select situations, IDD represents the optimal strategy for achieving these combined goals.