title: Clarifying the paradigm for the ethics of donation and transplantation: was 'dead' really so clear before organ donation?
abstract: Recent commentaries by Verheijde et al, Evans and Potts suggesting that donation after cardiac death practices routinely violate the dead donor rule are based on flawed presumptions. Cell biology, cardiopulmonary resuscitation, critical care life support technologies, donation and transplantation continue to inform concepts of life and death. The impact of oxygen deprivation to cells, organs and the brain is discussed in relation to death as a biological transition. In the face of advancing organ support and replacement technologies, the reversibility of cardiac arrest is now purely related to the context in which it occurs, in association to the availability and application of support systems to maintain oxygenated circulation. The 'complete and irreversible' lexicon commonly used in death discussions and legal statutes are ambiguous, indefinable and should be replaced by accurate terms. Criticism of controlled DCD on the basis of violating the dead donor rule, where autoresuscitation has not been described beyond 2 minutes, in which life support is withdrawn and CPR is not provided, is not valid. However, any post mortem intervention that re-establishes brain blood flow should be prohibited. In comparison to traditional practice, organ donation has forced the clarification of the diagnostic criteria for death and improved the rigour of the determinations.
authors: Division of Pediatric Critical Care, Extracorporeal Life Support Program, Montreal Children's Hospital, McGill University, Health Centre, Montreal, Quebec, Canada. sam.shemie@muhc.mcgill.ca
authors: Sam D
authors: SD
authors: Shemie
mesh_terms: D001926:Brain Death / Q000175:diagnosis*; D002560:Cerebrovascular Circulation; D006323:Heart Arrest / Q000503:physiopathology; D006801:Humans; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000941:ethics*
references: Acta Ophthalmol Scand. 2007 Jun;85(4):371-6
references: 17559462
references: JAMA. 1980 Dec 19;244(24):2750-1
references: 7441862
references: Resuscitation. 1999 Jun;41(1):87
references: 10459596
references: Crit Care Med. 2002 Apr;30(4 Suppl):S140-4
references: 11940789
references: Br J Dermatol. 1996 May;134(5):831-6
references: 8736321
references: Crit Care Med. 2003 Apr;31(4):1241-9
references: 12682499
references: CMAJ. 2006 Mar 14;174(6):S1-13
references: 16534069
references: Transplant Proc. 1996 Feb;28(1):165-6
references: 8644158
references: Can J Neurol Sci. 2008 May;35(2):140-5
references: 18574925
references: Can J Anaesth. 2006 Jun;53(6):620-7
references: 16738299
references: N Engl J Med. 2002 Feb 21;346(8):557-63
references: 11856794
references: FASEB J. 2002 Jan;16(1):54-60
references: 11772936
references: Resuscitation. 1998 Oct-Nov;39(1-2):125-8
references: 9918459
references: Chest. 1991 Feb;99(2):492-3
references: 1989814
references: Anesth Analg. 1992 Dec;75(6):1021-4
references: 1443682
references: Anaesth Intensive Care. 1991 Feb;19(1):118-21
references: 2012271
references: Philos Ethics Humanit Med. 2007 May 22;2:8
references: 17519030
references: Crit Care Med. 2001 Sep;29(9):1826-31
references: 11546995
references: Lancet Neurol. 2007 Jan;6(1):87-92
references: 17166805
references: Prog Transplant. 2001 Mar;11(1):58-66
references: 11357558
references: CMAJ. 2006 Oct 10;175(8):S1
references: 17124739
references: Transplant Proc. 2005 Nov;37(9):3857-8
references: 16386562
references: Philos Ethics Humanit Med. 2007 Jun 29;2:11
references: 17603889
references: JAMA. 1981 Nov 13;246(19):2184-6
references: 7289009
references: J Trauma. 2005 Jun;58(6):1095-101; discussion 1101-2
references: 15995454
references: Lancet. 1993 Mar 27;341(8848):841
references: 8096052
references: Anesthesiology. 1999 Aug;91(2):585-6
references: 10443636
references: Anesth Analg. 2001 Mar;92(3):690-2
references: 11226103
references: Arch Neurol. 1973 Dec;29(6):375-84
references: 4202405
references: Philos Ethics Humanit Med. 2007 Aug 24;2:17
references: 17718917