The circulatory-respiratory determination of death in organ donation.
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.
Bernat
James L
JL
Neurology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. bernat@dartmouth.edu
Capron
Alexander M
AM
Bleck
Thomas P
TP
Blosser
Sandralee
S
Bratton
Susan L
SL
Childress
James F
JF
DeVita
Michael A
MA
Fulda
Gerard J
GJ
Gries
Cynthia J
CJ
Mathur
Mudit
M
Nakagawa
Thomas A
TA
Rushton
Cynda Hylton
CH
Shemie
Sam D
SD
White
Douglas B
DB
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