Donation after cardiac death: major ethical issues.

• Author: Grasser, Phyllis L.
• Position: Reprint

7 NAT'L CATH. BIOETHICS Q. 527 (2007).

Are cardiac death (CD) donors truly dead? This is a complex and significant dilemma. After becoming aware of a wide variety of opinions on this ethical issue, the author has come to appreciate the importance of reports flora various groups of experts who have worked diligently to develop standards for defining death.

In 2004, the Joint Commission on Accreditation of Health Organizations (JCAHO) presented a white paper on organ donation that put forth "a call to action for those who influence, develop, or carry out policies that will lead the way to resolution of the identified issues." This report recommended that hospitals and organ transplant organizations "implement protocols for recovery of organs from donors after cardiac death." Also, in 2003, the Advisory Committee on Organ Transplantation of the U.S. Department of Health and Human Services unanimously agreed "that it is time for a requirement that all Class A hospitals at least begin the necessary ethical conversation about CD donation, involving both [intensive care unit] professionals and ancillary caregivers." Lack of agreement on determination-of-death criteria has been a roadblock to the development of sound ethical protocols for donation after cardiac death in particular.

In 2001, the Society of Critical Care Medicine (SCCM) stated that the three required elements of cardiopulmonary death criteria include "simultaneous and irreversible (1) unresponsiveness, (2) apnea, and (3) absent circulation." Another major controversial issue related to CD donation is how much time must pass after the cardiopulmonary criteria for death have been met before a person can actually be declared dead. This is important because obtaining organs from a patient before he dies would be homicide, even when a patient wants to die, or when done "to save the life of others."

According to the Pittsburgh protocol, CD is declared two minutes after cardiopulmonary criteria for death have...