When are you dead enough to be a donor? Can any feasible protocol for the determination of death on circulatory criteria respect the dead donor rule?

Abstract

The basic question concerning the compatibility of donation after circulatory death (DCD) protocols with the dead donor rule is whether such protocols can guarantee that the loss of relevant biological functions is truly irreversible. Which functions are the relevant ones? I argue that the answer to this question can be derived neither from a proper understanding of the meaning of the term “death” nor from a proper understanding of the nature of death as a biological phenomenon. The concept of death can be made fully determinate only by stipulation. I propose to focus on the irreversible loss of the capacity for consciousness and the capacity for spontaneous breathing. Having accepted that proposal, the meaning of “irreversibility” need not be twisted in order to claim that DCD protocols can guarantee that the loss of these functions is irreversible. And this guarantee does not mean that reversing that loss is either conceptually impossible or known to be impossible with absolute certainty.

Trends in Donation After Circulatory Death in Lung Transplantation in the United States: Impact Of Era

“…This process of how death is declared and the time frame for progression to death varies by center and jurisdiction ( 20 ). There is no universal protocol for sedation or allotted post-extubation time, and variations in these factors (within an OPO or hospital) has the potential to impact whether a donor organ can be procured ( 21 ). Other differences in logistical management by centers and OPOs create variability ( 22 ).…”

Consensus statement on normothermic regional perfusion in donation after circulatory death: Report from the European Society for Organ Transplantation’s Transplant Learning Journey

“…It is fundamental that NRP procedures are in accordance with the dead donor rule (organs can only be retrieved after determination of death, and death should never result from organ recovery) [36–38]. Definition of circulatory arrest and determination of death should be performed according to medical, professional and national standards [39–41].…”

Donation after cardiac death in heart transplantation: is there an ethical dilemma?

“…Herein lies the ethical dilemma of DCD donation, as it pertains to determining 'irreversibility' and whether this definition establishes permanence. Indeed, in DCD donation, the patient may not meet death criteria from a biological systems perspective of irreversibility, and thus, the moral dilemma ensues on whether removing vital organs from this patient causes death and thus violates our legal and moral obligations to the patient [7]. This would violate the dead donor rule (DDR) which prohibits procurement of organs from patients who cannot be declared dead [8].…”

“…Thus, our options are to abandon DDR or revise our definitions of irreversibility. den Hartogh [7] addresses this in his recent article in which he proposes two…”

“…So, how do we reconcile this dilemma. In an attempt to address this, Hartogh et al reviewed cases of autoresuscitation and found reports of autoresuscitation occurring up to 7 min after cessation of reanimation attempt [7]. So, we really do not know how much time must elapse for irreversibility to be met.…”