Donation after cardiac death: an overview

Abstract

The rapidly growing organ transplant list combined with the rising patient mortality while on this waiting list has prompted an interest in donors other than heart beating brain dead organ donors (HBOD). Organ donation after cardiac death (DCD) offers a possible solution to this exacerbated shortage of donor organs for transplantation. Under the DCD protocol, donors can be subdivided into controlled or uncontrolled categories. Due to warm ischaemia and deterioration of the quality of organs, uncontrolled donors are seldom used in the USA. The more widely used controlled DCD protocol attempts to approximate the ideal conditions for organ recovery that exist with organ procurement from heart beating donors. These donors are controlled because the timing and thus the process of donation are controlled through the timing of cardiopulmonary support. The controversy regarding the timing of death and the definition of irreversibility after cessation of cardiopulmonary activity continues to fuel the ongoing ethical debates regarding the criteria for death in DCD protocol. Despite every good intention to work within the framework of the dead donor rule, lack of uniform criteria surrounding the definition of death makes application of this rule challenging. In addition to establishing some uniformity in the criteria for death, it is time to consider abandoning the dead donor rule and consider the process of informed consent for organ donation.