Ethical Considerations in Supporting Donation after Circulatory Death: The Role of the Dead-Donor Rule

Abstract

There is a conflict between the wishes of terminally ill patients to allow withdrawal of treatment and become donors after cardiac death (DCD) and the limit on interventions required by the dead-donor rule (DDR). Once a breathing tube is removed, hours can pass before the patient expires. This interim time complies with the DDR, but often makes donation impossible. The consequences are the nullification of donors' wishes and the waste of organs for transplantation. Since the DDR was developed, attitudes on end-of-life interventions have evolved, organ donation has been embraced, and the field of organ transplantation has been firmly established. A new ethical approach is needed that, based on patients' autonomy, considers organ donation a goal of care and views the donated organs as having a profound value for the donor and recipient. It is time to prioritize patients' autonomous desire to donate life-giving organs to others and thus promote continuity of care for the donated organs over the modality of death pronouncement. To support patients' desire to be organ donors, the conversation should be open to allow medical intervention in the peri-extubation period.