Open Access Highly Accessed Review

Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent

Ari R Joffe12*, Joe Carcillo3, Natalie Anton1, Allan deCaen1, Yong Y Han4, Michael J Bell3, Frank A Maffei5, John Sullivan56, James Thomas7 and Gonzalo Garcia-Guerra1

Author Affiliations

1 Department of Pediatrics, University of Alberta, Stollery Children's Hospital; Edmonton Clinic Health Academy 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada

2 John Dossetor Health Ethics Center, University of Alberta, Edmonton, Alberta, Canada

3 Department of Pediatrics and Critical Care Medicine, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, 400 45th Street, Pittsburgh, PA, 15201, USA

4 Department of Pediatrics & Communicable Diseases, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

5 Department of Pediatrics, Pediatric Critical Care Medicine, Janet Weis Children's Hospital, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA

6 Golisano Children's Hospital at Strong, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY 15642, USA

7 Department of Pediatrics, University of Texas, Southwestern Medical Center; 5323 Harry Hines Blvd, Dallas, Texas, 75390-9063, USA

For all author emails, please log on.

Philosophy, Ethics, and Humanities in Medicine 2011, 6:17  doi:10.1186/1747-5341-6-17

Published: 29 December 2011

Abstract

Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD.

Keywords:
Dead donor rule; Death; Donation after cardiac death; Organ donation