Donation After Cardiac Death and the Emergency Department: Ethical Issues

Abstract

Organ donation after cardiac death (DCD) is increasingly considered as an option to address the shortage of organs available for transplantation, both in the United States and worldwide. The procedures for DCD differ from procedures for donation after brain death and are likely less familiar to emergency physicians (EPs), even as this process is increasingly involving emergency departments (EDs).

Protocols for Uncontrolled Donation After Circulatory Death: A Comprehensive Approach to Refractory Cardiac Arrest

“…While Spain pioneered the most active international program for uncontrolled (after unexpected cardiac arrest) DCD, 2-4 a recent internal cost-effectiveness analysis 2 revealed a high cost and low specificity in terms of the number of organs actually used. Simon et al 1 report similar outcomes in other protocols for uncontrolled DCD procedures.…”

“…[3][4][5] Our proposal would not only improve cost-effectiveness results, but also would clarify the status of patient-donors: by exploring all of the possibilities of high-quality cardiopulmonary and cerebral resuscitation, it minimizes the conflict of interest identified in EMS and ED professionals and the risk of compromising the treatment of these patients. 1 The proposal consists of implementing a comprehensive approach to refractory cardiac arrest and to subordinate the option of organ donation until after the failure of such an approach. According to the proposal, EMS and ED professionals, based on a validated predictive model and aligned with updated resuscitation guidelines, 4,6-10 select patients in refractory cardiac arrest who may benefit from available resuscitation techniques, seeking to restore their life with intact quality of life using extracorporeal resuscitation (ECPR) and/ or percutaneous coronary intervention (PCI) followed by hypothermia.…”

The ethics of organ donation, donation after circulatory determination of death, and xenotransplantation from an Islamic perspective

“…Furthermore, some protocols involve administering anticoagulants or vasodilators to the patient so as to preserve organ function prior to the declaration of death. 54,55 There is lively debate among bioethicists as to whether these antecedent activities are ethically justifiable because each of these procedures and medications has the potential to harm the donor while offering no therapeutic benefit. [56][57][58][59] Some argue that respect for persons and human dignity is trampled upon because the donor is treated as a means for the benefit of "others" prior to their death, while others assert that carrying out such procedures accords with fulfilling the wishes of the patient to donate; that when informed consent was obtained the donor accepted the potential risks of such procedures.…”

Cardiac Arrest, Resuscitation and Organ Donation: Joint Venture for Saving Lives One Way or Another. An Innovative and Ethically Sound Trail for Out-of- Hospital Cardiac Arrest

“…In fact, it allows to select from all patients in cardiac arrest those who would benefit from certain unconventional -but available and already used-resuscitation techniques, increasing the chances to reverse some sudden cardiac arrest considered irreversible until now [13,20]. At the same time, such an approach to considered refractory cardiac arrest is aligned with the goals of the most updated international guidelines on resuscitation, so would avoid existing conflicts of interest [1,9,20,21]. Such a conflicts are difficult to manage by health professionals who are faced with both the families of patients and the concerns of society as a whole [1,9,16,20,21].…”

“…At the same time, such an approach to considered refractory cardiac arrest is aligned with the goals of the most updated international guidelines on resuscitation, so would avoid existing conflicts of interest [1,9,20,21]. Such a conflicts are difficult to manage by health professionals who are faced with both the families of patients and the concerns of society as a whole [1,9,16,20,21]. Joining both strategies [1,9,20,22,23] and subordinating the eligibility as donor to the futility or failure of unconventional resuscitation in a case-by-case based decision, we could increase survival with quality of life in certain patients who have been considered medically hopeless, and this in itself is a clear improvement.…”