Determination of death in donation after circulatory determination of death

Abstract

With the evolution of medical technology, particularly resuscitation techniques, our way of understanding and determining death has been challenged. Donation after circulatory determination of death (DCDD) is one of these challenges. This thesis analyses in detail, through five articles, the determination of death in the context of DCDD. Notions of permanency and irreversibility, applied in the definition of death, are discussed. This distinction permits a better understanding of the non-congruence between our way of determining death in practice, i.e. based on permanent cessation of vital functions, and our understanding of death, which is usually based on their irreversible cessation. The dead donor rule (DDR) is also discussed, as it is a fundamental norm defended in transplantation medicine. The dead donor rule states that donors should not be killed for and by organ donation. Several critics argue that DCDD programs violate the DDR. Some of the articles presented in this thesis analyse the relevance of those critiques. This repertoire of articles offers a practical analysis of DCDD, based on different DCDD protocols, such as heart DCDD, uncontrolled and controlled DCDD, and the use of ECMO in DCDD. It also offers a more in depth analysis of the concept of death, suggesting the possibility of another way to determine death in the context of DCDD: the brain circulation determination of death.