The unique moral permissibility of uncontrolled lung donation after circulatory death

Parent, Brendan; Caplan, Arthur L.; Angel, Luis F.; Kon, Zachary N.; Dubler, Nancy Neveloff; Goldfrank, Lewis R.; Lindner, Jacob; Wall, Stephen P.

doi:10.1111/ajt.15603

Cited by 3 publications

(3 citation statements)

References 29 publications

(60 reference statements)

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“…RINTAG supports HRECs in ensuring that RDDT meets relevant legal and ethical standards for donation and transplantation [48]. In the case of research involving the recently deceased, we suggest that in the absence of specialist review boards for such research as proposed by Parent et al [49] all studies should be subject to review by HRECs, who should consult existing guidelines for research in the recently deceased [16], and expert bodies such as RINTAG.…”

Section: Ethical Guidance Is Needed To Address Barriers To Rdttmentioning

confidence: 99%

Addressing ethical confusion in deceased donation and transplantation research: the need for dedicated guidance

Martin

Cronin

Ave

et al. 2021

Transplant International

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Summary Innovative research in deceased donation and transplantation often presents ethical challenges for researchers and those responsible for ethical governance of research. These challenges have been recognized as potential barriers to the conduct of research. We review the literature to identify and describe ethical considerations that may cause confusion or uncertainty in the context of research involving potential deceased donors or deceased donor transplantation. We normatively examine these considerations and discuss their implications for the ethical conduct of research. In addition to the complexities of research involving critically ill, dying or recently deceased individuals, uncertainty may arise regarding the ethical status of various individuals who may be involved in research aimed at improving availability and outcomes of organ transplantation. Consequently, routine ethical guidelines for clinical research may fail to provide clear guidance with regards to the design, conduct and governance of some deceased donation or transplantation studies. Ethical uncertainty may result in delays or barriers to research, or neglect of important ethical considerations. Specific ethical guidance is needed to support research in deceased donation and transplantation as the ethical considerations that arise in the design and conduct of such research may not be addressed in the existing guidelines for human research.

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Section: Ethical Guidance Is Needed To Address Barriers To Rdttmentioning

confidence: 99%

Addressing ethical confusion in deceased donation and transplantation research: the need for dedicated guidance

Martin

Cronin

Ave

et al. 2021

Transplant International

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“…Many OPOs are not comfortable proceeding with organ recovery without NOK consent. It is imperative to ensure that the goal of organ transplantation does not negatively affect medical care for, or inappropriately hasten the death of a potential donor (37). However, there is an ethical argument to honor the wishes of the decedent who chose to be an organ donor.…”

Section: Challenges To Organ Recovery From Cdcdsmentioning

confidence: 99%

Donation after circulatory death donors in lung transplantation

Egan¹,

Haithcock²,

Lobo³

et al. 2021

J Thorac Dis

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Transplantation of any organ into a recipient requires a donor. Lung transplant has a long history of an inadequate number of suitable donors to meet demand, leading to deaths on the waiting list annually since national data was collected, and strict listing criteria. Before the Uniform Determination of Death Act (UDDA), passed in 1980, legally defined brain death in the U.S., all donors for lung transplant came from sudden death victims [uncontrolled Donation after Circulatory Death donors (uDCDs)] in the recipient's hospital emergency department. After passage of the UDDA, uDCDs were abandoned to Donation after Brain Death donors (DBDs)-perhaps prematurely. Compared to livers and kidneys, many DBDs have lungs that are unsuitable for transplant, due to aspiration pneumonia, neurogenic pulmonary edema, trauma, and the effects of brain death on lung function. Another group of donors has become available-patients with a devastating irrecoverable brain injury that do not meet criteria for brain death. If a decision is made by next-of-kin (NOK) to withdraw life support and allow death to occur by asphyxiation, with NOK consent, these individuals can have organs recovered if death occurs relatively quickly after cessation of mechanical ventilation and maintenance of their airway. These are known as controlled Donation after Circulatory Death donors (cDCDs). For a variety of reasons, in the U.S., lungs are recovered from cDCDs at a much lower rate than kidneys and livers. Ex-vivo lung perfusion (EVLP) in the last decade has had a modest impact on increasing the number of lungs for transplant from DBDs, but may have had a larger impact on lungs from cDCDs, and may be indispensable for safe transplantation of lungs from uDCDs. In the next decade, DCDs may have a substantial impact on the number of lung transplants performed in the U.S. and around the world.

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“…Additionally, ECMO cannulation can be done after the formal declaration of circulatory death, 49 for restoring the function of organs prior to procurement. The use of ECMO in this setting may increase the perception that the donor is not dead before organ procurement; this procedure is more easily used in countries where there is an opt-out consent procedure for donation, but in others where there is a need of a explicit consent for donation, there is also a consent to start ECMO, which could delay starting this procedure, 50 affecting the quality of the organ preservation.…”

Section: Ethical Issues Regarding Extracorporeal Membrane Oxygenation...mentioning

confidence: 99%

Ethical issues of organ donation after circulatory death: Considerations for a successful implementation in Chile

Castro

Salas

2021

Developing World Bioethics

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Organ transplantation is a lifesaving procedure for end‐organ damage and remains up to today as the most cost‐effective alternative to treat these conditions. However, the main limitation to performing organ transplants is the availability of donor organs suitable for transplantation. To increase the donor pool, expanding organ donation from the conventional neurologic determination of death (NDD) to include circulatory determination of death (DCD) has been a well‐established method of increasing donors in other countries. In this article, we discuss the clinical and ethical considerations for introducing DCD in Chile. The concepts we have used could very well be translatable to other similar countries which have not implemented this donation system yet. The most relevant issue to date is that DCD needs to alter the care of dying patients to obtain quality donor organs. In some countries, including Chile, there are some cultural barriers regarding withdrawal‐of‐care. These barriers include confusing withdrawal of care with acceleration of death, which leads to many practitioners refusing to remove artificial life support, and in turn only minimize ventilatory support or switch to a T‐tube (without extubation). This cultural barrier could be overcome with careful consideration of the opinions of healthcare workers, family members, community and policy‐based stakeholders. We also identified ethical issues related to informed consent of both donor and recipients, among other relevant ethical considerations. In conclusion, DCD donation in Chile can increase organ donation numbers in one of Latin America's countries with the lowest effective donor rate. However, this opportunity must be taken with caution to avoid the opposite effect if this policy is not well implemented, respecting the sound ethical principles mentioned in this paper.

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The unique moral permissibility of uncontrolled lung donation after circulatory death

Cited by 3 publications

References 29 publications

Addressing ethical confusion in deceased donation and transplantation research: the need for dedicated guidance

Addressing ethical confusion in deceased donation and transplantation research: the need for dedicated guidance

Donation after circulatory death donors in lung transplantation

Ethical issues of organ donation after circulatory death: Considerations for a successful implementation in Chile

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