Related Experiment Video
Updated: Dec 31, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Ethical and logistical concerns for establishing NRP-cDCD heart transplantation in the United States
Brendan Parent1, Nader Moazami2, Stephen Wall3,4
1Department of Population Health, Division of Medical Ethics, NYU Langone Health, New York, New York.
Insights
Controlled donation after circulatory determination of death (cDCD) can increase heart supply in the US. Addressing ethical and logistical issues, like ensuring irreversible cessation and informed consent, is crucial for successful implementation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Bioethics
Background:
- Controlled donation after circulatory determination of death (cDCD) is an established international practice with positive outcomes.
- Adoption in the United States could significantly increase the donor heart supply.
- Key ethical and logistical challenges must be comprehensively addressed for successful implementation.
Purpose of the Study:
- To explore the feasibility of adopting cDCD in the United States.
- To identify and address the ethical and logistical challenges associated with cDCD.
- To propose solutions for ensuring the integrity of the donation process.
Main Methods:
- Review of international cDCD practices and outcomes.
- Analysis of ethical considerations, including the definition of circulatory death and informed consent.
- Discussion of logistical requirements, such as normothermic regional perfusion (NRP) and team separation.
Main Results:
- Normothermic regional perfusion (NRP) is identified as an effective method to mitigate warm ischemia.
- Restarting circulation for NRP may challenge legal definitions of irreversible circulatory death.
- Ligating principal vessels can ensure natural progression to cessation of brain function, addressing concerns about irreversible cessation.
Conclusions:
- Implementing cDCD in the US requires careful consideration of ethical issues, including the timing of donation conversations and informed authorization.
- Maintaining public trust and medical integrity necessitates clear protocols for decision-making and team separation.
- The practice of cDCD, with appropriate safeguards, offers a viable strategy to enhance the donor heart supply.
Abstract:
Controlled heart donation after circulatory determination of death (cDCD) is well established internationally with good outcomes and could be adopted in the United States to increase heart supply if ethical and logistical challenges are comprehensively addressed. The most effective and resource-efficient method for mitigating warm ischemia after circulatory arrest is normothermic regional perfusion (NRP) in situ. This strategy requires restarting circulation after declaration of death according to circulatory criteria, which appears to challenge the legal circulatory death definition requiring irreversible cessation. Permanent cessation for life-saving efforts must be achieved to assuage this concern and ligating principal vessels maintains no blood flow to the brain, which ensures natural progression to cessation of brain function. This practice-standard in some countries-raises unique concerns about prioritizing life-saving efforts, informed authorization from decision-makers, and the clinician's role in the patient's death. To preserve public trust, medical integrity, and respect for the donor, the donation conversation must not take place until after an un-coerced decision to withdraw life-sustaining treatment made in accordance with the patient's treatment goals. The decision-maker(s) must understand cDCD procedure well enough to provide genuine authorization and the preservation/procurement teams must be kept separate from the clinical care team.
More Related Videos
07:08A High-Fidelity Porcine Model of Orthotopic Heart Transplantation Following Donation after Circulatory Death
Published on: June 6, 2025
09:54Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
