title: The circulatory-respiratory determination of death in organ donation.
abstract: OBJECTIVE
  Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory-respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory-respiratory death determination. We studied circulatory-respiratory death determination to clarify its concept, practice, and application to innovative circulatory determination of death protocols.
  
  
  RESULTS
  It is ethically and legally appropriate to procure organs when permanent cessation (will not return) of circulation and respiration has occurred but before irreversible cessation (cannot return) has occurred because permanent cessation: 1) is an established medical practice standard for determining death; 2) is the meaning of "irreversible" in the Uniform Determination of Death Act; and 3) does not violate the "Dead Donor Rule."
  
  
  CONCLUSIONS
  The use of unmodified extracorporeal membrane oxygenation in the circulatory determination of death donor after death is declared should be abandoned because, by restoring brain circulation, it retroactively negates the previous death determination. Modifications of extracorporeal membrane oxygenation that avoid this problem by excluding brain circulation are contrived, invasive, and, if used, should require consent of surrogates. Heart donation in circulatory determination of death is acceptable if proper standards are followed to declare donor death after establishing the permanent cessation of circulation. Pending additional data on "auto-resuscitation," we recommend that all circulatory determination of death programs should utilize the prevailing standard of 2 to 5 mins of demonstrated mechanical asystole before declaring death.
authors.affiliation: Neurology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. bernat@dartmouth.edu
authors.forename: James L
authors.initials: JL
authors.lastname: Bernat
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Capron
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Bleck
authors.forename: Sandralee
authors.initials: S
authors.lastname: Blosser
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.forename: James F
authors.initials: JF
authors.lastname: Childress
authors.forename: Michael A
authors.initials: MA
authors.lastname: DeVita
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Fulda
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Gries
authors.forename: Mudit
authors.initials: M
authors.lastname: Mathur
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Nakagawa
authors.forename: Cynda Hylton
authors.initials: CH
authors.lastname: Rushton
authors.forename: Sam D
authors.initials: SD
authors.lastname: Shemie
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
mesh_terms: D001926:Brain Death / Q000331:legislation & jurisprudence; D003643:Death; D004992:Ethics, Medical; D015199:Extracorporeal Membrane Oxygenation; D006323:Heart Arrest / Q000175:diagnosis*; D016027:Heart Transplantation / Q000941:ethics* / Q000331:legislation & jurisprudence; D006801:Humans; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000331:legislation & jurisprudence; D014481:United States