Practical Considerations in Donation After Circulatory Determination of Death in Switzerland

Abstract

Faced with similar issues of organ scarcity to its neighbors, Switzerland has developed donation after circulatory determination of death (DCDD) as a way to expand the organ pool since 1985. Here, we analyze the history, practical considerations, and ethical issues relating to the Swiss donation after circulatory death programs. In Switzerland, determination of death for DCDD requires a stand-off period of 10 minutes. This time between cardiac arrest and the declaration of death is mandated in the guidelines of the Swiss Academy of Medical Sciences. As in other DCDD programs, safeguards are put to avoid physicians denying lifesaving treatment to savable patients because of being influenced by receivers’ interest. An additional recommendation could be made: Recipients should be transparently informed of the worse graft outcomes with DCDD programs and given the possibility to refuse such organs.

Keywords

donation after circulatory determination of death Switzerland ethical issues

Get full access to this article

View all access options for this article.

References

Weber

Dindo

Demartines

Ambuhl

Clavien

. Kidney transplantation from donors without a heartbeat. N Engl J Med. 2002;347(4):248–255.

Swisstransplant. Annual Report Swisstransplant 2014 and 2013. 2014. https://www.swisstransplant.org/fileadmin/user_upload/Swisstransplant/Jahresbericht/SWT_de_Jahresbericht_2014.pdf. Accessed June 8, 2017.

Rady

Verheijde

McGregor

. Scientific, legal, and ethical challenges of end-of-life procurement in emergency medicine. Resuscitation. 2010;81(9):1069–1078. doi:10.1016/j.resuscitation.2010.05.007.

Joffe

Carcillo

Anton

. Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent. Philos Ethics Humanit Med. 2011;6:17. doi:10.1186/1747-5341-6-17. Accessed June 8, 2017.

Dalle Ave

Bernat

. Using the brain criterion in organ donation after the circulatory determination of death. J Crit Care. 2016;33:114–118. doi:10.1016/j.jcrc.2016.01.005.

Federal Assembly of the Swiss Confederation. Federal Act on the Transplantation of Organs, Tissues and Cells (Transplantation Act) 810.21. https://www.admin.ch/opc/en/classified-compilation/20010918/index.html. Accessed June 8, 2017.

Swiss Academy of Medical Sciences. Ethical guidelines on the determination of death in the context of organ transplantation. 2011. https://www.swisstransplant.org/fileadmin/user_upload/Organspende/Allg._PDF/e_SAMW_FeststellungTod_11.pdf Access June 8, 2017.

Bernat

. How the distinction between ‘irreversible’ and ‘permanent’ illuminates circulatory-respiratory death determination. J Med Philos. 2010;35(3):242–255. doi:10.1093/jmp/jhq018.

Dalle Ave

Shaw

. Controlled donation after circulatory determination of death. J Intensive Care Med. 2017;32(3):179–186. doi:10.1177/0885066615625628.

10.

Dalle Ave

Shaw

Bernat

. Ethical issues in the use of extracorporeal membrane oxygenation in controlled donation after circulatory determination of death. Am J Transplant. 2016;16(8):2293–2299. doi:10.1111/ajt.13792.

11.

Dalle Ave

Shaw

Gardiner

. Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-An ethical analysis of an unresolved clinical dilemma. Resuscitation. 2016;108:87–94. doi:10.1016/j.resuscitation.2016.07.003.

12.

Summers

Watson

Pettigrew

. Kidney donation after circulatory death (DCD): state of the art. Kidney Int. 2015;88(2):241–249. doi:10.1038/ki.2015.88.

13.

Dalle Ave

Shaw

. Donation after circulatory determination of death: what information to whom? Bioethica Forum. 2016;9(1):32–38.