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Ethical Decision Diagrams on Donation After Cardiocirculatory Death Heart Transplantation Considering Organ
Lars Saemann1,2, Matthias Karck1, Sevil Korkmaz-Icöz1
1Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany.
Insights
Ethical decision-making for heart transplantation from donors after cardiocirculatory determined death (DCD-HTx) is complex. Developed decision diagrams offer a structured approach to navigate these ethical challenges for donors, families, and recipients.
Area of Science:
- Medical Ethics
- Transplantation Surgery
- Organ Donation
Background:
- Organ shortage necessitates utilizing hearts from donors after cardiocirculatory determined death (DCD) for heart transplantation (HTx).
- DCD-HTx presents unique ethical conflicts for donors, families, and recipients.
- Existing ethical frameworks lack structured decision-making tools for DCD-HTx.
Purpose of the Study:
- To address the ethical complexities surrounding DCD-HTx.
- To develop structured decision diagrams for ethical considerations in DCD-HTx.
Main Methods:
- An interdisciplinary group reviewed relevant literature.
- Ethical conflicts were analyzed from donor, family, and recipient perspectives.
- Decision diagrams were developed based on identified ethical aspects.
Main Results:
- Donor perspective discussions centered on the "standoff period" and definition of death.
- Recipient perspective highlighted the desire for farewell and ethical concerns regarding organ procurement techniques.
- Ethical questions arose concerning organ preservation methods.
Conclusions:
- Ethical decision-making in DCD-HTx is intricate.
- The developed decision diagrams provide a structured method for processing ethical questions.
- These tools can aid in navigating complex ethical scenarios in DCD-HTx.
Background:
To overcome organ shortage, some centers accept hearts from cardiocirculatory determined death (DCD) donors for heart transplantation (HTx). DCD-HTx is attached with special ethical conflicts on the donor, family, and recipient side. Ethically motivated decisions also have to be made considering organ preservation techniques. However, ethical decision diagrams, which can be applied to find a final answer on the complex field of ethical questions, have not been developed yet.
Methods:
In an interdisciplinary group of clinical ethicists, transplantation surgeons, transplantation researchers, and perfusionists, after review of relevant literature, we focused on crucial ethical aspects on DCD-HTx in general and separated ethical conflicts with regard to the individual perspective of the donor, family, and recipient.
Results:
The leading aspect of discussion in the donor perspective mainly deals with the standoff period and with the definition of death. The perspective of recipients focuses on the wish to say farewell after the patient is deceased. In the recipient perspective ethical questions regarding organ procurement techniques occur.
Conclusions:
Ethical decision-making on DCD-HTx is complex, but it can be processed in a structured way by applying the decision diagrams that we have developed.
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