What Are the Ethics Involved in Donation After Circulatory-Determined Death?

Donation after circulatory determined death (DCD)is a protocol that allows doctors to retrieve organs from a person who does not meet the strict neurological criteria for brain death. In this scenario, the patient has usually suffered an injury or illness from which they will never fully recover, such as a catastrophic head injury or a massive stroke. They cannot breathe or maintain circulatory function without the aid of machines, and doctors have determined with reasonable certainty that they never will. 

If a patient’s family or surrogate decision-maker agrees to donation after circulatory determined death, the potential donor is taken to the operating room (or a location very close to the operating room) and taken off life support. If breathing and heart function don’t resume within 2 to 5 minutes, the person is declared dead and the abdominal organs are removed. Typically, hearts and lungs are not harvested from patients who have donated after cardiac death because these organs are exquisitely sensitive to oxygen deprivation and are more likely to suffer irreparable damage before the transplant can occur. However, extracorporeal membrane oxygenation (ECMO) has recently been used to successfully reperfuse hearts that were removed from a DCD donor, offering hope that these organs can one day be harvested and transplanted successfully. 

Despite its utility, donation after circulatory-determined death is ethically controversial.This ethical dilemma derives mainly from the 2 to 5 minute time limit, which is necessarily brief. (Organs deprived of oxygen for longer than 5 minutes will begin to die.) Opponents of the practice argue that there is a possibility that the patient might resume breathing on their own if surgery was delayed. And, in fact, some patients will breathe unassisted after life support is stopped, in which case the organ harvest does not occur.

Additionally, the accepted medical definition of “death” states that death must be irreversible. Thus, some ethicists believe that if breathing and circulatory function can be restored (through CPR and continued life support) the person cannot be declared dead. 

For these reasons, some hospitals and physicians refuse to participate in donation after circulatory-determined death. Nonetheless, DCD is an accepted practice in many hospitals across the United States. 

Sources

“Ethical Controversies in Organ Donation After Circulatory Death”. American Academy of Pediatrics. https://publications.aap.org/pediatrics/article/131/5/1021/31250/Ethical-Controversies-in-Organ-Donation-After?autologincheck=redirected