Controlled Donation After Circulatory Determination of Death: A Scoping Review of Ethical Issues, Key Concepts, and Arguments

Abstract

Controlled donation after circulatory determination of death (cDCDD) is an important strategy for increasing the pool of eligible organ donors.

Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021

“…Safeguarding end‐of‐life experience for MAiD patients in the ODE context requires active monitoring, given the potential for changes to the benefit/harm balance with these, sick, vulnerable patients, unlike unconscious withdrawal of life‐sustaining therapy patients. Examples include burdensome assessments during their final days of life, painful interventions, the presence of unknown healthcare teams during MAiD, a different setting for MAiD, changes to the family's experience, and bereavement due to the removal of the body for several hours 59,77,92,95,99,100–116 …”

“…Examples include burdensome assessments during their final days of life, painful interventions, the presence of unknown healthcare teams during MAiD, a different setting for MAiD, changes to the family's experience, and bereavement due to the removal of the body for several hours. 59 , 77 , 92 , 95 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 …”

“…Examples include burdensome assessments during their final days of life, painful interventions, the presence of unknown healthcare teams during MAiD, a different setting for MAiD, changes to the family's experience, and bereavement due to the removal of the body for several hours. 59,77,92,95,99,[100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116] The Dutch guideline incorporates choices about varying levels of premortal intervention burden as an explicit part of the donor pathway consent process, with the patient deciding the level of burden they wish to endure and OPO representatives then deciding which organs can be procured based on the premortal interventions appropriate to this level of imposed burden. 59 In contrast…”

Decision-making About Premortem Interventions for Donation: Navigating Legal and Ethical Complexities

“…9 Several authors have observed that ethical and legal confusion about PMI decision-making may result in practices that may not meet established standards 10 and could undermine public support for and participation in deceased donation. 5,11 Although there is limited evidence about the impact of such confusion, we suggest that this lack of clarity regarding when PMIs may lawfully be used may act as a barrier to their use and could be a factor contributing to missed opportunities for transplantation in some jurisdictions.…”

Neurologic Physiology after Removal of Therapy (NeuPaRT) study: study protocol of a multicentre, prospective, observational, pilot feasibility study of neurophysiology after withdrawal of life-sustaining measures

“…Current organ donation after circulatory determination of death (DCDD) processes assume, but do not explicitly confirm , permanent loss of brain activity when death is determined 5 min after circulatory arrest. While this assumption is rooted in a strong physiological rationale, a lack of neurophysiological evidence regarding cessation of brain activity in humans contributes to ethical concerns1 and ongoing mistrust of the DCDD process among healthcare and public stakeholders 2–4. Healthcare providers may have uncertainty that waiting 5 min after circulatory arrest is sufficient to declare death in DCDD and ensure a permanent cessation of all brain activity prior to organ retrieval 2–5.…”