title: Uncontrolled Donation After Circulatory Determination of Death: A Systematic Ethical Analysis.
abstract: Uncontrolled donation after circulatory determination of death (uDCDD) refers to organ donation after a refractory cardiac arrest. We analyzed ethical issues raised by the uDCDD protocols of France, Madrid, and New York City. We recommend: (1) Termination of resuscitation (TOR) guidelines need refinement, particularly the minimal duration of resuscitation efforts before considering TOR; (2) Before enrolling in an uDCDD protocol, physicians must ascertain that additional resuscitation efforts would be ineffective; (3) Inclusion in an uDCDD protocol should not be made in the outpatient setting to avoid error and conflicts of interest; (4) The patient's condition should be reassessed at the hospital and reversible causes treated; (5) A no-touch period of at least 10 minutes should be respected to avoid the risk of autoresuscitation; (6) Once death has been determined, no procedure that may resume brain circulation should be used, including cardiopulmonary resuscitation, artificial ventilation, and extracorporeal membrane oxygenation; (7) Specific consent is required prior to entry into an uDCDD protocol; (8) Family members should be informed about the goals, risks, and benefits of planned uDCDD procedures; and (9) Public information on uDCDD is desirable because it promotes public trust and confidence in the organ donation system.
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 Neurology Department, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Bernat
mesh_terms: D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation; D000066491:Clinical Decision-Making; D002985:Clinical Protocols; D016265:Conflict of Interest; D003643:Death; D026689:Ethical Analysis; D005190:Family; D005602:France; D006266:Health Education; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007258:Informed Consent; D009519:New York City; D013030:Spain; D009626:Terminology as Topic; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000379:methods; D028761:Withholding Treatment
keywords: ECMO-assisted CPR (E-CPR); cardiopulmonary resuscitation (CPR); extracorporeal membrane oxygenation (ECMO); out-of-hospital cardiac arrest (OHCA); uncontrolled donation after circulatory determination of death (uDCDD)