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Recovery of transplantable organs after cardiac or circulatory death: Transforming the paradigm for the ethics of organ donation

Joseph L Verheijde1, Mohamed Y Rady2* and Joan McGregor3

Author Affiliations

1 Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, Arizona, 85054, USA

2 Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, Arizona, 85054, USA

3 Department of Biomedical Ethics and Medical Humanities Program, College of Medicine-Phoenix, University of Arizona and Department of Philosophy, Arizona State University, 300 East University Drive, Tempe, Arizona, 85287, USA

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Philosophy, Ethics, and Humanities in Medicine 2007, 2:8  doi:10.1186/1747-5341-2-8

Published: 22 May 2007


Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination.