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Donation after cardiac death in heart transplantation: is there an ethical dilemma?
Arturo Cardounel1, Walker Julliard
1Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Insights
Donation after cardiac death (DCD) offers an alternative to traditional organ donation, but raises ethical questions about meeting death criteria and legal obligations. This review examines DCD protocols and their ethical compliance.
Area of Science:
- Medical Ethics
- Transplantation Medicine
- Legal Medicine
Background:
- Organ shortages necessitate alternative donation strategies.
- Donation after cardiac death (DCD) is increasingly used in the USA.
- Existing donation paradigms include donation after brain death (DBD).
Purpose of the Study:
- To review the medico-legal and ethical aspects of DCD donation.
- To address the expansion of DCD as an organ procurement strategy.
- To analyze compliance of DCD protocols with regulatory guidelines.
Main Methods:
- Review of current DCD protocols.
- Analysis of ethical considerations in DCD.
- Examination of legal frameworks, including the Uniform Determination of Death Act (UDDA).
Main Results:
- DCD protocols may not align with biological irreversibility criteria for death.
- Ethical dilemmas arise regarding organ removal and patient obligations.
- The UDDA criteria for death focus on circulatory and brain function irreversibility.
Conclusions:
- DCD protocols must comply with regulatory guidelines.
- Respecting patient and surrogate wishes through informed consent is crucial.
- Ethical considerations in DCD are paramount for end-of-life care and organ donation.
Purpose Of Review:
In an attempt to address the organ shortages in heart transplantation, USA centres have begun utilizing donation after cardiac death (DCD) as an alternative to traditional donation after brain death (DBD). As this paradigm continues to expand, there is a need to address the medico-legal and ethical aspects of DCD donation, which is the focus of the current review.
Recent Findings:
Current protocols use criteria established by the Uniform Determination of Death Act (UDDA), which is explicit in defining the irreversibility of circulation and brain function in determining death. By the nature of DCD, the patient may not meet death criteria from a biological systems perspective of irreversibility, and thus, the moral dilemma ensues on whether removing vital organs violates our legal and moral obligations to the patient.
Summary:
In the current article, we review the ethical issues raised with DCD and define DCD protocols and their ability to comply with established regulatory guidelines while respecting the wishes of patients and their surrogates through informed decisions making about organ donation and end-of-life care.
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