Donation after brain circulation determination of death
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Published on: April 17, 2020
Anne L Dalle Ave1, James L Bernat2
1Ethics Unit, University hospital of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland. Anne.Dalle-Ave@chuv.ch.
Insights
Donation after brain circulation determination of death (DBCDD) defines death by permanent cessation of brain circulation and function. This ensures accurate organ donation criteria and informed consent.
Area of Science:
- Medical Ethics
- Organ Donation
- Neurology
Background:
- The primary factor in death is the irreversible cessation of brain circulation and function.
- Current organ donation protocols require re-evaluation for accuracy.
Purpose of the Study:
- To propose a new term and framework for organ donation after circulatory determination of death.
- To establish clear criteria for death declaration in organ donation contexts.
Main Methods:
- Defining death based on permanent cessation of brain circulation.
- Implementing safeguards against errors in death determination.
- Emphasizing informed consent for organ donation.
Main Results:
- Donation after brain circulation determination of death (DBCDD) allows death declaration when circulatory cessation is permanent but not yet irreversible.
- Safeguards include verifying circulatory cessation, ensuring no resumption of brain circulation, and confirming permanent loss of brain function.
- Brain death tests are deemed unnecessary; systemic circulation cessation is the definitive criterion.
Conclusions:
- Death in DBCDD is defined by the permanent cessation of brain function, evidenced by the permanent cessation of brain circulation.
- Consensus among stakeholders is crucial due to the divergence from current standards.
- Informed consent must be obtained from patients or surrogates regarding the basis of death declaration.
Background:
The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD].
Results:
In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation of brain function is permanent and complete. Death should be determined by the confirmation of the cessation of systemic circulation; the use of brain death tests is invalid and unnecessary. Because this concept differs from current standards, consensus should be sought among stakeholders. The patient or surrogate should provide informed consent for organ donation by understanding the basis of the declaration of death.
Conclusion:
In cases of circulatory cessation, such as occurs in DBCDD, death can be defined as the permanent cessation of brain functions, determined by the permanent cessation of brain circulation.
