Expanding controlled donation after the circulatory determination of death: statement from an international collaborative.
Authors
Ascher, Nancy
Capron, Alexander M
Gardiner, Dale
Manara, Alexander R
Bernat, James L
Miñambres, Eduardo
Singh, Jeffrey M
Porte, Robert J
Markmann, James F
Dhital, Kumud
Ledoux, Didier
Fondevila, Constantino
Hosgood, Sarah
Van Raemdonck, Dirk
Keshavjee, Shaf
Dubois, James
McGee, Andrew
Henderson, Galen V
Glazier, Alexandra K
Tullius, Stefan G
Shemie, Sam D
Delmonico, Francis L
Publication Date
2021-03Journal Title
Intensive Care Med
ISSN
0342-4642
Publisher
Springer Science and Business Media LLC
Volume
47
Issue
3
Pages
265-281
Language
en
Type
Other
This Version
VoR
Metadata
Show full item recordCitation
Domínguez-Gil, B., Ascher, N., Capron, A. M., Gardiner, D., Manara, A. R., Bernat, J. L., Miñambres, E., et al. (2021). Expanding controlled donation after the circulatory determination of death: statement from an international collaborative.. [Other]. https://doi.org/10.1007/s00134-020-06341-7
Abstract
A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.
Keywords
Determination of death, Donation after the circulatory determination of death, Normothermic regional perfusion, Organ perfusion, Organ repair, Organ transplantation, Tissue and organ procurement, Withdrawal of life-sustaining therapy, Death, Humans, Organ Transplantation, Quality of Life, Tissue Donors, Tissue and Organ Procurement
Identifiers
s00134-020-06341-7, 6341
External DOI: https://doi.org/10.1007/s00134-020-06341-7
This record's DOI: https://doi.org/10.17863/CAM.78977
Rights
Licence:
http://creativecommons.org/licenses/by-nc/4.0/
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