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Organ Procurement After Cardiocirculatory Death: A Critical Analysis

Departments of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, Arizona, rady.mohamed{at}mayo.edu

Joseph L. Verheijde, PhD, MBA

Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Phoenix, Arizona

Joan McGregor, PhD

Bioethics, Policy, and Law Program, Arizona State University, Tempe, Arizona

To shorten the transplantation waiting time in the United States, federal regulations have been introduced requiring hospitals to develop policies for organ donation after cardiac (or circulatory) death (DCD). The practice of DCD is invoked based on the validity of the University of Pittsburgh Medical Center (UPMC) protocol and relies on the accuracy of the University of Wisconsin (UW) evaluation tool to appropriately identify organ donors. There is little evidence to support the position that the criteria for organ procurement adopted from the UPMC protocol complies with the dead donor rule. A high false-positive rate of the UW evaluation tool can expose many dying patients to unnecessary perimortem interventions because of donation failure. The medications and/or interventions for the sole purpose of maintaining organ viability can have unintended negative consequences on the timing and quality of end-of-life care offered to organ donors. It is essential to address and manage the evolving conflict between optimal end-of-life care and the necessary sacrifices for the procurement of transplantable organs from the terminally ill. The recipients of marginal organs recovered from DCD can also suffer higher mortality and morbidity than recipients of other types of donated organs. Finally, transparent disclosure to the public of the risks involved to both organ donors and recipients may contribute to open societal debate on the ethical acceptability of DCD.

Key Words: cardiocirculatory death • ethics • organ donation • organ procurement • transplantation

This version was published on September 1, 2008

Journal of Intensive Care Medicine, Vol. 23, No. 5, 303-312 (2008)
DOI: 10.1177/0885066608320928


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