Repository logo
 

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative.

Published version
Peer-reviewed

Change log

Authors

Domínguez-Gil, Beatriz  ORCID logo  https://orcid.org/0000-0002-5695-8993
Ascher, Nancy 
Capron, Alexander M 
Gardiner, Dale 
Manara, Alexander R 

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.

Description

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

Is Part Of

Publisher

Springer Science and Business Media LLC