Problematising the ethics of organ donation after circulatory death in the UK

Cooper, Jessie

doi:10.1080/09581596.2016.1225948

Cited by 7 publications

(4 citation statements)

References 33 publications

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“…National policies and guidelines have attempted to shape the process of cDCD into a routine activity for healthcare professionals so that it can become an accepted practice ( 15 , 27 ). Ethical frameworks imply that healthcare professionals should not experience a moral tension between caring for the dying patient and altering his/her care for the purpose of donation.…”

Section: Discussionmentioning

confidence: 99%

“A Delicate balance”—Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study

Dorze

Martouzet²,

Cassiani-Ingoni³

et al. 2022

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Controlled donation after circulatory death (cDCD) is considered by many as a potential response to the scarcity of donor organs. However, healthcare professionals may feel uncomfortable as end-of-life care and organ donation overlap in cDCD, creating a potential barrier to its development. The aim of this qualitative study was to gain insight on the perceptions and experiences of intensive care units (ICU) physicians and nurses regarding cDCD. We used thematic analysis of in-depth semi-structured interviews and 6-month field observation in a large teaching hospital. 17 staff members (8 physicians and 9 nurses) participated in the study. Analysis showed a gap between ethical principles and routine clinical practice, with a delicate balance between end-of-life care and organ donation. This tension arises at three critical moments: during the decision-making process leading to the withdrawal of life-sustaining treatments (LST), during the period between the decision to withdraw LST and its actual implementation, and during the dying and death process. Our findings shed light on the strategies developed by healthcare professionals to solve these ethical tensions and to cope with the emotional ambiguities. cDCD implementation in routine practice requires a shared understanding of the tradeoff between end-of-life care and organ donation within ICU.

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Section: Discussionmentioning

confidence: 99%

“A Delicate balance”—Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study

Dorze

Martouzet²,

Cassiani-Ingoni³

et al. 2022

Transpl Int

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“…As previously commented (Cooper, 2017), the debates around DCD are not uniquely located within the UK. Arguments over the dilemmas involved in DCD were ignited in 1992 with the introduction in the US of what became known as the 'Pittsburgh Protocol for non-heartbeating organ donation', which advocated aggressive organ preservation techniques and the removal of organs two minutes after the donor's heart stopped.…”

Section: Dcd and Its Controversies: Situating (Ethical) Concerns In Organ Transplantationmentioning

confidence: 93%

“…All of these policies focus on the importance of assessing the 'best' or 'overall' interest of the dying patient; they justify end-of-life interventions to facilitate DCD when it is understood that the dying patient would have wanted donation and that further life-sustaining treatment is not of overall benefit (AoMRC/UK DEC, 2011;BTS, 2013). The policies therefore focus on standardising the ethical-legal frameworks around DCD, as a way of enabling the renewal of this controversial technology (Bernat, 2008;Cooper, 2017).…”

Section: Dcd and Its Controversies: Situating (Ethical) Concerns In Organ Transplantationmentioning

confidence: 99%

Organs and organisations: Situating ethics in organ donation after circulatory death in the UK

Cooper

2018

Social Science & Medicine

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Controlled organ donation after circulatory death (DCD) has recently been revived in the UK, as part of attempts to increase organ donation rates. The re-introduction of DCD has subsequently become the focus of bioethical controversy, since it necessitates intervening in the care of dying patients to obtain quality donor organs. Transplant policy responses to these concerns have generated new legal and ethical guidelines to address uncertainties around DCD, producing claims that the UK has overcome' the ethical challenge of DCD. In contrast, by drawing on Lynch's call to 'respecify' ethics, this paper argues that ethics in DCD cannot be reduced to abstract directives for practice, but, instead, are composed and dealt with as an organisational problem. To do this, I utilise data from an ethnographic study examining the production of the 'minority ethnic organ donor' within UK organ donation settings; in particular, the data pertains to a case hospital which was in the process of developing a DCD programme during the period of fieldwork. Findings show that the ethics of DCD are encountered as practical sets of problems, constructed in relation to particular institutional locales. I describe how these issues are worked-around by creating conditions to make DCD organisationally possible, and through the animation of standard procedures into acceptable forms of practice. I argue that ethics in DCD go far beyond normative bioethical principles, to encompass concerns around: the reputation of hospital Trusts, public perceptions of organ donation, the welfare of potential donor families, and challenges to the work of health professionals caring for dying patients. The paper enriches understanding of ethics in science and medicine by showing how ethics are assembled and negotiated as a practical-organisational concern, and calls for further examination of how DCD gets constructed as a potential problem and is made to happen in practice.

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“…The ODTs recommendations proceeded debates in clinical and bioethics literatures about the ethical implications of DCD. These centred on whether DCD violates a broad interpretation of the dead donor rule (that living patients should not be treated 'as though they were dead' for the purposes of organ donation); whether potential donors receive appropriate care at the endof-life (due to DCD necessitating alterations to end-of-life care); and debates about when death can be declared and organs removed (Cooper, 2017;Gardiner & Sparrow, 2010: 17).…”

Section: Introductionmentioning

confidence: 99%

Time, resourcing, and ethics: how the routinisation of organ donation after circulatory death in the NHS has created new ethical issues

Cooper

2021

Critical Public Health

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Controlled Organ Donation after Circulatory Death (DCD) was re-introduced in the UK in 2008, in efforts to increase rates of organs for transplant. Following reintroduction there were debates about the ethics of DCD, leading to production of legal and ethical guidelines. Today, DCD makes up 40% of deceased organ donors, leading to claims that the UK has 'overcome' its ethical challenges. However, there is little understanding of how DCD works in practice and the ethical implications of making DCD routine in the context of the NHS. This paper draws on data from an ethnographic study examining the practices of DCD in two acute NHS Trusts in England. Interviews with Intensive Care staff and Specialist Nurses in organ donation, observations of organ donation committee meetings and analysis of Trust documents were conducted. Findings reveal that the routinisation of DCD has created new ethical issues relating to interactions between organisational timeframes for DCD and (under)resourcing for, and deprioritisation of, donation within an NHS subject to austerity. They include: the perceived burden on families and implications for consent when there are delays in the donation process, due to theatre space and retrieval team shortages; family and staff distress when death does not Author copy. To cite this article: Jessie Cooper (2021): Time, resourcing, and ethics: how the routinisation of organ donation after circulatory death in the NHS has created new ethical issues, Critical Public Health,

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Problematising the ethics of organ donation after circulatory death in the UK

Cited by 7 publications

References 33 publications

“A Delicate balance”—Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study

“A Delicate balance”—Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study

Organs and organisations: Situating ethics in organ donation after circulatory death in the UK

Time, resourcing, and ethics: how the routinisation of organ donation after circulatory death in the NHS has created new ethical issues

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