Donation after cardiocirculatory death

A call for a moratorium pending full public disclosure and fully informed consent

Ari R. Joffe, Joe Carcillo, Natalie Anton, Allan deCaen, Yong Y. Han, Michael J. Bell, Frank A. Maffei, John Sullivan, James Thomas, Gonzalo Garcia-Guerra

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD.

Original languageEnglish (US)
Article number17
JournalPhilosophy, Ethics, and Humanities in Medicine
Volume6
Issue number1
DOIs
StatePublished - Dec 29 2011

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Disclosure
Informed Consent
Conflict of Interest
Tissue and Organ Procurement
Donation
Double Effect Principle
Consensus

Keywords

  • Dead donor rule
  • Death
  • Donation after cardiac death
  • Organ donation

ASJC Scopus subject areas

  • Health Policy
  • History and Philosophy of Science
  • Issues, ethics and legal aspects
  • Medicine(all)

Cite this

Donation after cardiocirculatory death : A call for a moratorium pending full public disclosure and fully informed consent. / Joffe, Ari R.; Carcillo, Joe; Anton, Natalie; deCaen, Allan; Han, Yong Y.; Bell, Michael J.; Maffei, Frank A.; Sullivan, John; Thomas, James; Garcia-Guerra, Gonzalo.

In: Philosophy, Ethics, and Humanities in Medicine, Vol. 6, No. 1, 17, 29.12.2011.

Research output: Contribution to journalArticle

Joffe, AR, Carcillo, J, Anton, N, deCaen, A, Han, YY, Bell, MJ, Maffei, FA, Sullivan, J, Thomas, J & Garcia-Guerra, G 2011, 'Donation after cardiocirculatory death: A call for a moratorium pending full public disclosure and fully informed consent', Philosophy, Ethics, and Humanities in Medicine, vol. 6, no. 1, 17. https://doi.org/10.1186/1747-5341-6-17
Joffe, Ari R. ; Carcillo, Joe ; Anton, Natalie ; deCaen, Allan ; Han, Yong Y. ; Bell, Michael J. ; Maffei, Frank A. ; Sullivan, John ; Thomas, James ; Garcia-Guerra, Gonzalo. / Donation after cardiocirculatory death : A call for a moratorium pending full public disclosure and fully informed consent. In: Philosophy, Ethics, and Humanities in Medicine. 2011 ; Vol. 6, No. 1.
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