title: Organ donation after circulatory death: the forgotten donor?
abstract: Donation after circulatory death (DCD) can be performed on neurologically intact donors who do not fulfill neurologic or brain death criteria before circulatory arrest. This commentary focuses on the most controversial donor-related issues anticipated from mandatory implementation of DCD for imminent or cardiac death in hospitals across the USA. We conducted a nonstructured review of selected publications and websites for data extraction and synthesis. The recommended 5 min of circulatory arrest does not universally fulfill the dead donor rule when applied to otherwise neurologically intact donors. Scientific evidence from extracorporeal perfusion in circulatory arrest suggests that the procurement process itself can be the event causing irreversibility in DCD. Legislative abandonment of the dead donor rule to permit the recovery of transplantable organs is necessary in the absence of an adequate scientific foundation for DCD practice. The designation of organ procurement organizations or affiliates to obtain organ donation consent introduces self-serving bias and conflicts of interest that interfere with true informed consent. It is important that donors and their families are not denied a 'good death', and the impact of DCD on quality of end-of-life care has not been satisfactorily addressed to achieve this.
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic Hospital, Mayo Clinic College of Medicine, 5777 East Mayo Blvd, Phoenix, Arizona 85054, USA. rady.mohamed@mayo.edu
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Rady
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Verheijde
authors.forename: Joan
authors.initials: J
authors.lastname: McGregor
mesh_terms: D001775:Blood Circulation; D001926:Brain Death / Q000175:diagnosis / Q000503:physiopathology; D003643:Death; D006801:Humans; D014019:Tissue Donors / Q000941:ethics; D020858:Tissue and Organ Harvesting / Q000941:ethics / Q000379:methods; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000379:methods*