The American Thoracic Society provided a framework to guide ethics and health policy considerations in adult and pediatric controlled donation after circulatory determination of death (DCDD) in its official statement on DCDD in the July 1, 2013 issue of the American Journal of Respiratory and Critical Care Medicine.
The statement provides ethics and policy considerations on five aspects of controlled DCDD: consent, interventions, determination of death, end-of-life care, and pediatric DCDD.
“Increased use of DCDD organs could have a substantial impact on the chronic shortage of donor organs available for transplantation, but as the consent and management of potential DCDD donors occurs before death, it raises a number of important ethical and policy issues,” said Cynthia Gries, MD, MSc, assistant professor of medicine and clinical translational sciences in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pittsburgh Medical Center and chair of the committee that drafted the statement. “This statement, which incorporates input from a number of critical care and transplant societies, addresses those issues.”
Some recommendations included in the statement regarding consent include disclosure about ante-mortem interventions and medications, identified as being administered solely for the purpose of organ donation, to surrogate decision makers at the time of consent.
Additional guidance notes that information about how death will be determined should be provided to the patient or the surrogates and hospitals participating in DCDD should have a clear policy regarding how and where patients will be cared for if they do not expire within the time interval acceptable for donation.
The ATS developed the statement with input from the Society of Critical Care Medicine, the International Society for Heart and Lung Transplantation, the Association of Organ Procurement Organizations, and the United Network of Organ Sharing. The information presented in the statement is based on the current evidence, experience, and clinical rationale.
