Article

Report of a National Conference on Donation after cardiac death.

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
American Journal of Transplantation (Impact Factor: 6.19). 03/2006; 6(2):281-91. DOI: 10.1111/j.1600-6143.2005.01194.x
Source: PubMed

ABSTRACT A national conference on organ donation after cardiac death (DCD) was convened to expand the practice of DCD in the continuum of quality end-of-life care. This national conference affirmed the ethical propriety of DCD as not violating the dead donor rule. Further, by new developments not previously reported, the conference resolved controversy regarding the period of circulatory cessation that determines death and allows administration of pre-recovery pharmacologic agents, it established conditions of DCD eligibility, it presented current data regarding the successful transplantation of organs from DCD, it proposed a new framework of data reporting regarding ischemic events, it made specific recommendations to agencies and organizations to remove barriers to DCD, it brought guidance regarding organ allocation and the process of informed consent and it set an action plan to address media issues. When a consensual decision is made to withdraw life support by the attending physician and patient or by the attending physician and a family member or surrogate (particularly in an intensive care unit), a routine opportunity for DCD should be available to honor the deceased donor's wishes in every donor service area (DSA) of the United States.

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    ABSTRACT: L’écart croissant entre le besoin et la disponibilité des organes destinés à la transplantation de même que l’augmentation du nombre de familles voulant effectuer le don des organes d’un proche ont mené les différents acteurs de ce milieu à reconsidérer les donneurs en décès cardiocirculatoire à la suite d’une décision d’arrêt des traitements de maintien des fonctions vitales (TMFV). Quoique le don d’organes après décès cardiocirculatoire (DDC) ait été abandonné, dans les années 1960, pour des raisons médicales, la reprise de cette pratique suscite tout de même plusieurs questionnements de nature éthique. Le présent travail présente donc une recension des différents enjeux éthiques attribuables à cette pratique qui est suivi d’une analyse critique de ceux-ci à l’aide l’approche bioéthique par principes. Les résultats de cette analyse ont ensuite servis de guide afin d’évaluer les composantes éthiques du protocole du projet pilote québécois de DDC. Une conclusion s’est dégagée à l’effet que certaines lignes de conduites doivent être respectées afin que la pratique du DDC soit en accord avec l’approche bioéthique par principes. The rising gap between organs need and its availability and the increasing number of family requests about loved ones organ donation have lead the transplant actors to reconsider the cardiac arrest donor after withdrawing life-sustaining treatment decision. This practice resumption creates many questions about ethics stakes that will be discussed and analyzed according to the principle bioethics approach. Although organ donation after cardiac death (DCD) has been abandoned in the 1960s, for medical reasons, the resumption of this practice still raises several questions of an ethical nature. This work presents a review of various ethical issues resulting from this practice, which is followed by a critical analysis of these with the approach by bioethics principles. The results of this analysis were then used as guide to evaluate the ethical components of the protocol of the DCD pilot project of Quebec. A conclusion was reached to the effect that certain lines of conduct must be met in order that the practice of DCD is consistent with the approach by bioethics principles. Fondation Marc Chouinard
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