Author:
Omelianchuk Adam,Capron Alexander Morgan,Ross Lainie Friedman,Derse Arthur R.,Bernat James L.,Magnus David
Abstract
AbstractIn transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's—more and higher‐quality organs and more efficient allocation—can be achieved by removing organs from deceased donors and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call “ethical parsimony,” which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy‐makers should favor NMP over NRP.
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3. “Donation after circulatory determination of death” is sometimes abbreviated as “DCD ” which is confusing because “DCD” was previously used for “donation after cardiac death” and “donation after circulatory death” and because those phrases suggest that the absence of cardiac activity or circulatory and respiratory functions is “death” rather than the means by which death is determined. When the withdrawal of life-sustaining treatment is planned the procedure is called “controlled DCDD”; the “uncontrolled” version which is practiced in about half of the countries in Europe but not in the United States involves donors who experienced a sudden cardiopulmonary arrest in or outside a hospital when either they could not be resuscitated or no attempt to resuscitate them was made.
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5. “Deceased Donors Recovered in the U.S. by Circumstance of Death National Data: January 1 1988-December 31 2023 ” U.S. Department of Health and Human Services Health Resources and Service Administration Organ Procurement and Transplantation Network athttps://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#. To reach the results reported in our text first choose the category “Donor” and choose “All Organs.” Then choose this report:All Donors by Donor Type. After the screen changes select “Add field to report: Donation after Circulatory Death (DCD).” The results displayed for 2023 were 10 442 in what the OPTN terms the “Brain Death Donor” category and 5894 in the “DCD Donor” category.
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