title: Controlled Donation After Circulatory Determination of Death.
abstract: Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of cDCDD protocols and the ethical literature. Our analysis confirms that W-LST procedures vary considerably among cDCDD centers and that despite existing recommendations, the conflict of interest in the W-LST decision and process might be difficult to avoid, the process of W-LST might interfere with usual end-of-life care, and there is a risk of hastening death. In order to ensure that the practice of W-LST meets already well-established ethical recommendations, we suggest that W-LST should be managed in the ICU by an ICU physician who has been part of the W-LST decision. Recommending extubation for W-LST, when this is not necessarily the preferred procedure, is inconsistent with the recommendation to follow usual W-LST protocol. As the risk of conflicts of interest in the decision of W-LST and in the process of W-LST exists, this should be acknowledged and disclosed. Finally, when cDCDD programs interfere with W-LST and end-of-life care, this should be transparently disclosed to the family, and specific informed consent is necessary.
authors.affiliation: 1 Ethics Unit, University hospital of Lausanne, Lausanne, Switzerland.|2 Institute for Biomedical Ethics, University Medical Center, Geneva, Switzerland.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Dalle Ave
authors.affiliation: 3 Institute for Biomedical Ethics, University of Basel, Bernoullistrasse, Basel, Switzerland.
authors.forename: David M
authors.initials: DM
authors.lastname: Shaw
mesh_terms: D016265:Conflict of Interest; D003657:Decision Making; D019983:Guideline Adherence / Q000941:ethics*; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D011368:Professional-Family Relations / Q000941:ethics*; D013727:Terminal Care / Q000941:ethics; D014019:Tissue Donors / Q000941:ethics*; D009927:Tissue and Organ Procurement / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics*
keywords: controlled donation after circulatory determination of death; ethics; transplantation; withdrawal of life-sustaining therapy