Anne Laure Dalle Ave1, David Shaw2, James L Bernat3. 1. Ethics Unit, University Hospital of Lausanne, Switzerland Institute for Biomedical Ethics, Geneva, Switzerland. 2. Institute for Biomedical Ethics, Universität Basel, Basel, Switzerland. 3. Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Abstract
BACKGROUND: Heart donation after circulatory determination of death (DCDD) has provoked ethical debate focused primarily on whether heart DCDD donors are dead when death is declared and when organs are procured. OBJECTIVE AND DESIGN: We rigorously analyse whether four heart DCDD programmes (Cape Town, Denver, Australia, Cambridge) respect the dead donor rule (DDR), according to six criteria of death: irreversible cessation of all bodily cells function (or organs), irreversible cessation of heart function, irreversible cessation of circulation, permanent cessation of circulation, irreversible cessation of brain function and permanent cessation of brain function. CONCLUSIONS: Only death criteria based on permanency are compatible with the DDR under two conditions: (1) a minimum stand-off period of 5 min to ensure that autoresuscitation is impossible and that all brain functions have been lost and (2) no medical intervention is undertaken that might resume bodily or brain circulation. By our analysis, only the Australia heart DCDD programme using a stand-off period of 5 min respects the DDR when the criteria of death are based on permanency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: Heart donation after circulatory determination of death (DCDD) has provoked ethical debate focused primarily on whether heart DCDD donors are dead when death is declared and when organs are procured. OBJECTIVE AND DESIGN: We rigorously analyse whether four heart DCDD programmes (Cape Town, Denver, Australia, Cambridge) respect the dead donor rule (DDR), according to six criteria of death: irreversible cessation of all bodily cells function (or organs), irreversible cessation of heart function, irreversible cessation of circulation, permanent cessation of circulation, irreversible cessation of brain function and permanent cessation of brain function. CONCLUSIONS: Only death criteria based on permanency are compatible with the DDR under two conditions: (1) a minimum stand-off period of 5 min to ensure that autoresuscitation is impossible and that all brain functions have been lost and (2) no medical intervention is undertaken that might resume bodily or brain circulation. By our analysis, only the Australia heart DCDD programme using a stand-off period of 5 min respects the DDR when the criteria of death are based on permanency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
Dead donor rule; Donation/Procurement of Organs/Tissues; Hearts
Authors: Alex Manara; Sam D Shemie; Stephen Large; Andrew Healey; Andrew Baker; Mitesh Badiwala; Marius Berman; Andrew J Butler; Prosanto Chaudhury; John Dark; John Forsythe; Darren H Freed; Dale Gardiner; Dan Harvey; Laura Hornby; Janet MacLean; Simon Messer; Gabriel C Oniscu; Christy Simpson; Jeanne Teitelbaum; Sylvia Torrance; Lindsay C Wilson; Christopher J E Watson Journal: Am J Transplant Date: 2020-01-27 Impact factor: 8.086