Declaration of cardiorespiratory death, as defined by the Uniform Determination of Death Act (UDDA), requires irreversible cessation of circulatory and respiratory function. A physician’s ability to confidently declare death is paramount because death is both a biological and social construct, and can afford a dying patient the opportunity to be an organ donor via donation after circulatory death (DCD). Inconsistencies related to cardiorespiratory death and DCD include the specific language used in the UDDA, specifically the use of the word “irreversible”. Additionally, in DCD there is a large focus on the auto-resuscitative capacity of the heart, however recently some have argued that instead the focus should shift to the brain and a determination of how long it needs to be without circulation to cease functioning prior to declaring death. In this paper, I discuss inconsistencies with cardiorespiratory death as they pertain to organ donation and posit several possible solutions to mitigate these inconsistencies.
Ad hoc committee of the Harvard medical school to examine the definition of brain death. A definition of irreversible coma. JAMA1968;
208: 85–88.
2.
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: A Report on the Medical, Legal and Ethical Issues in the Determination of Death, July 1981. Washington DC: US Government Printing Office.
3.
TruogRD.Defining death: Lessons from the case of jahi McMath. Pediatrics2020;
146: S75–S80.
4.
BouffardK. Bobby Reyes dies after UM takes him off life support. The Detroit News, www.detroitnews.com (2019, accessed 15 October 2019).
5.
AvrilT. At CHOP, two boys were diagnosed with brain death. Here’s what that means. The Philadelphia Inquirer, www.inquirer.com (2018, accessed 24 May 2018).
6.
TruogRDMillerFG.Changing the conversation about brain death. Am J Bioeth2014;
14: 9–14.
7.
RobertsonJA.The dead donor rule. Hastings Cent Rep1999;
29: 6–14.
8.
NakagawaTAAshwalSMathurM, et al.
Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Pediatrics2011;
128: e720–e740.
9.
GreerDMShemieSDLewisA, et al.
Determination of brain death/death by neurologic criteria: The world brain death project. JAMA2020;
324: 1078–1097.
10.
VeatchRM.Controversies in defining death: A case for choice. Theor Med Bioeth2019;
40: 381–401.
11.
CapronAM.Brain death – Well settled yet still unresolved. N Engl J Med2001;
344: 1244–1246.
12.
BoucekMMMashburnCDunnSM, et al.
Pediatric heart transplantation after declaration of cardiocirculatory death. N Engl J Med2008;
359: 709–714.
13.
DeVitaMASnyderJV.Development of the university of pittsburgh medical center policy for the care of the terminally ill patients who may become organ donors after death following the removal of life support. Kennedy Inst Ethics J1993;
3: 131–143.
14.
VerganoMMagavernEBaroncelliF, et al.
Making a case for controlled organ donation after cardiac death: the story of Italy’s first experience. J Crit Care2017;
38: 129–131.
15.
Institute of Medicine, National Academy of Sciences. Non-Heartbeating Organ Transplantation: medical and Ethical Issues in Procurement.
Washington DC:
National Academies Press, 1997.
16.
Academy of Medical Royal Colleges.A Code of Practice for the Diagnosis and Confirmation of Death.
London, UK:
Academy of Medical Royal Colleges, 2008.
17.
DeVitaMA.The death watch: Certifying death using cardiac criteria. Prog Transpl2001;
11: 58–66.
18.
CurfmanGDMorrisseySDrazenJM.Cardiac transplantation in infants. N Engl J Med2008;
359: 749–750.
19.
Institute of Medicine, National Academy of Sciences. Non-Heart-Beating Organ Transplantation: Practice and Protocols.
Washington DC:
National Academy Press, 2000.
20.
BarkerCFMarkmannJF.Historical overview of transplantation. Cold Spring Harb Perspect Med2013;
3: a014977.
21.
ColemanNLBonnerA.Exploring Australian intensive care physicians clinical judgement during donation after cardiac death: An exploratory qualitative study. Aust Crit Care2014;
27: 172–176.
22.
VeatchRM.Donating hearts after cardiac death – Reversing the irreversible. N Engl J Med2008;
359: 672–673.
23.
BernatJL.The boundaries of organ donation after circulatory death. N Engl J Med2008;
359: 669–671.
24.
TruogRDMillerFG.The dead donor rule and organ transplantation. N Engl J Med2008;
359: 674–675.
25.
BernatJL.Point: Are donors after circulatory death really dead, and does it matter? Yes and yes. Chest2010;
138: 13–16.
26.
TruogRDMillerFG.Counterpoint: Are donors after circulatory death really dead, and does it matter? No and not really. Chest2010;
138: 16–18.
27.
BernatJL.Conceptual issues in DCDD donor death determination. Hastings Cent Rep2018;
48: S26–S28.
28.
HornbyLDhananiSShemieSD.Update of a systematic review of autoresuscitation after cardiac arrest. Crit Care Med2018;
46: e268–e272.
29.
ShethKNNutterTSteinDM.Autoresuscitation after asystole in patients being considered for organ donation. Crit Care Med2012;
40: 158–161.
30.
DhananiSHornbyLWardR, et al.
Canadian critical care trials group and in collaboration with the bertram loeb chair and research consortium in organ and tissue donation: vital signs after cardiac arrest following withdrawal of life-sustaining therapy: A multicenter prospective observational study. Crit Care Med2014;
42: 2358–2369.
31.
VeatchRM.Are organ donors really dead: The near irrelevance of autoresuscitation. Am J Bioeth2018;
18: 1–2.
32.
SiminoffLABurantCYoungnerSJ.Death and organ procurement: Public beliefs and attitudes. Kennedy Inst Ethics J2004;
14: 217–234.
33.
KompanjeEde GrootYJ.Autoresuscitation is not a determinant to lower the observation time in declaring death for organ donation. Crit Care Med2012;
40:708.
34.
BorjiginJLeeULiuT, et al.
Surge of neurophysiological coherence and connectivity in the dying brain. Proc Natl Acad Sci USA2013;
110: 14432–14437.
35.
NortonLGibsonRMGoftonT, et al.
Electroencephalographic recordings during withdrawal of life-sustaining therapy until 30 minutes after declaration of death. Can J Neurol Sci2017;
44: 139–145.
36.
DreierJPMajorSForemanB, et al.
Terminal spreading depolarization and electrical silence in death of human cerebral cortex. Ann Neurol2018;
83: 295–310.
37.
TruogRDRobinsonWM.Role of brain death and the dead-donor rule in the ethics of organ transplantation. Crit Care Med2003;
31: 2391–2396.
38.
KatznelsonGKatznelsonGClarkeH.Revisiting the anaesthesiologist’s role during organ procurement. Anaesthesiol Intensive Ther2018;
50: 91–94.
39.
VeatchRMRossLF.Defining Death: The Case for a Choice. Washington, DC: Georgetown University Press, 2016. pp.147–156.
40.
PageAMesserSLargeSR.Heart transplantation from donation after circulatory determined death. Ann Cardiothorac Surg2018;
7: 75–81.
41.
NiederbergerPFarineERaillardM.Heart transplantation with donation after circulatory death. Circ Heart Fail2019;
12: e005517.
42.
MagnusDA.Defense of the dead donor rule. Hastings Cent Rep2018;
48: S26–S38.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
