Clarifying the DDR and DCD

Restoring the Organism as a Whole: Does NRP Resurrect the Dead?

The introduction of normothermic regional perfusion (NRP) in controlled donation after circulatory determination of death (cDCDD) protocols is by some regarded as controversial and ethically troublesome. One of the main concerns that opponents have about introducing NRP in cDCDD protocols is that reestablishing circulation will negate the determination of death by circulatory criteria, potentially resuscitating the donor. In this article, I argue that this is not the case. If we take a closer look at the concept of death underlying the circulatory criterion for determination of death, we find that the purpose of the criterion is to show whether the organism as a whole has died. I argue that this purpose is fulfilled by the circulatory criterion in cDCDD protocols, and that applying NRP does not negate the determination of death or resuscitate the donor.

The Unified Brain-Based Determination of Death Conceptually Justifies Death Determination in DCDD and NRP Protocols

Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act.

Organ Donation and the Dead Donor Rule: A Synopsis of Pressing Ethical Controversies and Practical Questions

OBJECTIVES

As a result of recent biomedical advancements, organ donation continues to save and enhance countless lives globally.Yet,the gap between the organ supply and demand persists, leading to approximately 17 people dying each day waiting for an organ transplant and another person being added to the transplant waiting list every 9 minutes. This gap persists, in part, because of ethical and practical concerns arising from ambiguities surrounding death determination before donation and the dead donor rule. In this study, we discuss challenges related to defining death in the context of organ donation, critical and tolerant views on the dead donorrule, and possible avenues by which some of the ambiguities and ethicaltensions related to organ donation may be resolved.

MATERIALS AND METHODS

We reviewed literature opinions and data pertaining to cultural and religious influences affecting societal attitudes toward death determination and organ donation and examined the future of deceased organ donation.

RESULTS

Cultural and religious influences affect societal attitudes toward death determination and organ donation. There is a plurality of views on the matter that may be assuaged to an extent by standardized death determination criterion that could be implemented globally or by identifying alternative therapies other than human organ transplant.

CONCLUSIONS

The debate regarding death and the acceptability of dead donor organs fortransplant does not have a straightforward solution, and efforts are needed to overcome social, cultural and religious objections.