Cardio-pulmonary resuscitation of brain-dead organ donors: a literature review and suggestions for practice

Ave, Anne L. Dalle; Gardiner, Dale; Shaw, David

doi:10.1111/tri.12623

Cited by 23 publications

(20 citation statements)

References 29 publications

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“…Hypothermia is among numerous therapies applied to brain-dead organ donors to improve recipient outcomes. Cardiopulmonary resuscitation (CPR) is another 2. When these treatments are applied to brain-dead donors, their ‘therapeutic’ value refers to benefits for recipients.…”

Section: Can Brain-dead Individuals Be Benefited or Harmed By Medicalmentioning

confidence: 99%

Is there a place for CPR and sustained physiological support in brain-dead non-donors?

Brown

2017

J Med Ethics

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This article addresses whether cardiopulmonary resuscitation (CPR) and sustained physiological support should ever be permitted in individuals who are diagnosed as brain dead and who had held previously expressed moral or religious objections to the currently accepted criteria for such a determination. It contrasts how requests for care would normally be treated in cases involving a brain-dead individual with previously expressed wishes to donate and a similarly diagnosed individual with previously expressed beliefs that did not conform to a brain-based conception of death. The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor's requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society.

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Section: Can Brain-dead Individuals Be Benefited or Harmed By Medicalmentioning

confidence: 99%

Is there a place for CPR and sustained physiological support in brain-dead non-donors?

Brown

2017

J Med Ethics

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“…The use of a technique or procedure to preserve organs for transplantation, ''rather than to save the patient's life'' 47 Organ-preserving CPR (OP-CPR) 48 The use of chest compression, artificial ventilation, and fluids in cases of cardiac arrest ''to preserve organs for transplantation, rather than to revive the patient'' 48 Organ-preserving ECMO (OP-ECMO) 47 The use of ECMO to preserve organs for transplantation, ''rather than save the patient's life'' 47 Other terminologies: ECMO, 24,42 normothermic regional circulation, normothermic abdominal recirculation, normothermic ECMO (NECMO), 45 extracorporeal circulation femorofemoral bypass with membrane oxygenation under normothermic condition 6 Cold organ preservation solution ECMO 16 The use of cold organ preservation solution through ECMO instead of blood to preserve organ perfusion for transplantation…”

Section: Organ-preserving Techniquesmentioning

confidence: 99%

Uncontrolled Donation After Circulatory Determination of Death: A Systematic Ethical Analysis

Ave

Bernat

2016

J Intensive Care Med

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Uncontrolled donation after circulatory determination of death (uDCDD) refers to organ donation after a refractory cardiac arrest. We analyzed ethical issues raised by the uDCDD protocols of France, Madrid, and New York City. We recommend: (1) Termination of resuscitation (TOR) guidelines need refinement, particularly the minimal duration of resuscitation efforts before considering TOR; (2) Before enrolling in an uDCDD protocol, physicians must ascertain that additional resuscitation efforts would be ineffective; (3) Inclusion in an uDCDD protocol should not be made in the outpatient setting to avoid error and conflicts of interest; (4) The patient's condition should be reassessed at the hospital and reversible causes treated; (5) A no-touch period of at least 10 minutes should be respected to avoid the risk of autoresuscitation; (6) Once death has been determined, no procedure that may resume brain circulation should be used, including cardiopulmonary resuscitation, artificial ventilation, and extracorporeal membrane oxygenation; (7) Specific consent is required prior to entry into an uDCDD protocol; (8) Family members should be informed about the goals, risks, and benefits of planned uDCDD procedures; and (9) Public information on uDCDD is desirable because it promotes public trust and confidence in the organ donation system.

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“…We have not directly compared the ethical considerations of ‘crash’ organ removal to OP‐ECMO in this study, but accept that the treating clinician should consider such an option if severe hemodynamic instability occurs. The role for the initiation of cardiopulmonary resuscitation in such circumstances is complex, and we have explored this in another publication .…”

Section: Ethical Analysis Of Op‐ecmomentioning

confidence: 99%

“…We define ‘organ‐preserving extracorporeal membrane oxygenation (OP‐ECMO)’ as the use of extracorporeal support not to save the patients’ life, but to preserve their organs for transplantation; in a similar manner to ‘organ‐preserving cardiopulmonary resuscitation or OP‐CPR’, which we defined in a previous article . Although OP‐ECMO can be used in the context of Donation after Circulatory Determination of Death (DCDD) programs, we choose in this study to focus on the use of OP‐ECMO in the context of Donation after Brain Determination of Death (DBDD).…”

Section: Introductionmentioning

confidence: 99%

The ethics of extracorporeal membrane oxygenation in brain-dead potential organ donors

Ave¹,

Gardiner

Shaw

2016

Transpl Int

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SUMMARYOrgan-preserving extracorporeal membrane oxygenation (OP-ECMO) is defined as the use of extracorporeal support for the primary purpose of preserving organs for transplantation, rather than to save the patient's life. This paper discusses the ethics of using OP-ECMO in donation after brain determination of death (DBDD) to avoid the loss of organs for transplantation. We review case reports in the literature and analyze the ethical issues raised. We conclude that there is little additional ethical concern in continuing OP-ECMO in patients already on ECMO if they become brain dead. The implementation of OP-ECMO in hemodynamically unstable brain-dead patients is ethically permissible in certain clinical situations but requires specific consent from relatives if the patient's wish to donate is not clear. If no evidence of a patient's wish to donate is available, OP-ECMO is not recommended. In countries with presumed consent legislation, failure to opt out should be considered as a positive wish to donate. If a patient is not-yet brain-dead or is undergoing testing for brain death, OP-ECMO is not recommended. Further research on OP-ECMO is needed to better understand the attitudes of professionals, families, and lay people to ensure agreement on key ethical issues.

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Cardio-pulmonary resuscitation of brain-dead organ donors: a literature review and suggestions for practice

Cited by 23 publications

References 29 publications

Is there a place for CPR and sustained physiological support in brain-dead non-donors?

Is there a place for CPR and sustained physiological support in brain-dead non-donors?

Uncontrolled Donation After Circulatory Determination of Death: A Systematic Ethical Analysis

The ethics of extracorporeal membrane oxygenation in brain-dead potential organ donors

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