scholarly journals Effect of organ donation after circulatory determination of death on number of organ transplants from donors with neurologic determination of death

2017 ◽  
Vol 189 (38) ◽  
pp. E1206-E1211 ◽  
Author(s):  
Vivek Rao ◽  
Sonny Dhanani ◽  
Janet MacLean ◽  
Clare Payne ◽  
Elizabeth Paltser ◽  
...  
Keyword(s):  
Organ Donation ◽  
Organ Transplants ◽  
Determination Of Death

Death and dying

2019 ◽  
pp. 579-589
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Organ Donation ◽  
Death And Dying ◽  
Best Interests ◽  
Life Care ◽  
Determination Of Death ◽  
Brainstem Death ◽  
Donation After Brain Death

This chapter discusses death and dying, and includes discussion on confirming death using neurological criteria (brainstem death), withdrawing and withholding treatment, organ donation after brain death (DBD), and organ donation after circulatory determination of death (DCD). Death is common in the intensive care unit (ICU) and it is important to identify patients whose condition meets the criteria for brainstem death testing as well as patients where continued treatment is not considered to be in their overall best interests. Confirming death using neurological criteria allows the relatives to be presented with the certainty of a diagnosis of death whether organ donation is possible or not. Decisions to withraw treatment are common in the ICU and are associated with approximately 50% of all deaths in the ICU. The decision is made by the multidisciplinary team in consultation with the patient’s relatives and taking into account the patient’s values and preferences. In both situations the possibility of organ donation should be considered and explored, and, when it is a possibility, it should be routinely offered to the relatives as an end-of-life care option.

scholarly journals Organ Donation Following Neurologic and Circulatory Determination of Death

2018 ◽  
Vol 19 ◽  
pp. S26-S32 ◽  
Author(s):  
Thomas A. Nakagawa ◽  
Sam D. Shemie ◽  
Karen Dryden-Palmer ◽  
Christopher S. Parshuram ◽  
Joe Brierley
Keyword(s):  
Organ Donation ◽  
Determination Of Death

Non-Heart-Beating Organ Donation: A Defense of the Required Determination of Death

1999 ◽  
Vol 27 (2) ◽  
pp. 126-136 ◽  
Author(s):  
James M. DuBois
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Function ◽  
Medical Treatment ◽  
Organ Donation ◽  
Organ Procurement ◽  
Determination Of Death ◽  
Heart Beating ◽  
The Family ◽  
Transplant Team

The family of a patient who is unconscious and respirator-dependent has made a decision to discontinue medical treatment. The patient had signed a donor card. The family wants to respect this decision, and agrees to non-heart-beating organ donation. Consequently, as the patient is weaned from the ventilator, he is prepped for organ explantation. Two minutes after the patient goes into cardiac arrest, he is declared dead and the transplant team arrives to begin organ procurement. At the time retrieval begins, it is not certain that the patient's brain is dead or that cardiac function cannot be restored. Procurement follows uneventfully, and two transplantable kidneys are retrieved.Many people now consider such cases of non-heart-beating organ donation to be ethically permissible. However, widespread disagreement persists as to how such practices are to be justified and whether such practices are compatible with the Uniform Declaration of Death Act (UDDA). In this paper, I argue that non-heart-beating organ donation can be ethically justified, that in the justified cases the patients are in fact dead, and that the early declarations of death required for such donation do comply with the UDDA.

scholarly journals The ethical and legal implications of the Human Tissue Amendment Act 2020 (Vic)

2021 ◽  
Vol 23 (3) ◽  
pp. 245-247
Author(s):  
Steve Philpot ◽  
◽  
David Anderson ◽  
◽  
◽  
...  
Keyword(s):  
Organ Donation ◽  
Human Tissue ◽  
Medical Practitioner ◽  
Determination Of Death ◽  
Medical Practitioners ◽  
Legal Implications ◽  
Tissue Act ◽  
Human Tissue Act ◽  
Circulation Of The Blood

The Human Tissue Act 1982 (Vic) has recently been amended by the Human Tissue Amendment Act 2020(Vic). In an effort to better reflect the modern practice of organ donation, the intention of the amendment is to include a process for the authorisation of ante-mortem procedures in patients being considered for organ donation after circulatory determination of death(DCDD). As part of this process, the amendment introduces a new requirement for consent for such ante-mortem procedures, and specifies that: A designated officer for a hospital must not give an authority … in respect of a person unless, where the respiration or the circulation of the blood of the person is being maintained by artificial means, two registered medical practitioners, neither of whom is the designated officer and each of whom has been for a period of not less than five years a registered medical practitioner, have each certified in writing — ​ that the practitioner has carried out a clinical examination of the person while the respiration or the circulation of the blood of that person was being maintained by artificial means; and that, in the practitioner’s opinion, at the time of examination, death of the person would occur as a result of the withdrawal of the artificial means of maintaining the respiration or the circulation of the blood of the person.

scholarly journals Solid organ donation from the emergency department – A systematic review

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 626-637 ◽  
Author(s):  
Jessica McCallum ◽  
Brittany Ellis ◽  
Sonny Dhanani ◽  
Ian G. Stiell
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Organ Donation ◽  
Meta Analysis ◽  
Healthcare Team ◽  
Solid Organ ◽  
Organ Donors ◽  
Determination Of Death ◽  
Eligibility Criteria

ABSTRACTObjectivesA significant gap exists between people awaiting an organ transplant and organ donors. The purpose of this study was to determine what percent of successful donors come from the emergency department (ED), whether there are any missed donors, and to identify factors associated with successful and missed donation.MethodsThis systematic review used electronic searches of EMBASE, MEDLINE, and CINAHL according to PRISMA guidelines on July 7, 2017. We included primary literature in adults describing successful and missed organ donation. Two authors independently screened articles, and discrepancies were resolved through consensus. Quality was assessed using the STROBE checklist.ResultsThis systematic review identified 1,058 articles, and 25 articles were included. For neurologic determination of death, ED patients comprised 4%–50% of successful donors and 3.6%–8.9% of successful donors for donation after circulatory determination of death. ED death reviews revealed up to 84% of missed neurologic determination of death, and 46.2% of missed circulatory determination of death donors who died in the ED are missed due to a failure to refer for consideration of organ donation. Clinical heterogeneity precluded pooling of the data to conduct a meta-analysis.ConclusionsThe ED is a source of actual and missed donors. Potential donors are often missed due to incorrect assumptions regarding eligibility criteria and failure of the healthcare team to refer for consideration of donation. ED healthcare professionals should be aware of organ donation referral protocols at their institution to ensure that no organ donors are missed.

Uncontrolled Donation After Circulatory Determination of Death: A Systematic Ethical Analysis

2016 ◽  
Vol 33 (11) ◽  
pp. 624-634 ◽  
Author(s):  
Anne L. Dalle Ave ◽  
James L. Bernat
Keyword(s):  
New York ◽  
Organ Donation ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Public Information ◽  
Outpatient Setting ◽  
Determination Of Death ◽  
Risks And Benefits ◽  
Made In

Uncontrolled donation after circulatory determination of death (uDCDD) refers to organ donation after a refractory cardiac arrest. We analyzed ethical issues raised by the uDCDD protocols of France, Madrid, and New York City. We recommend: (1) Termination of resuscitation (TOR) guidelines need refinement, particularly the minimal duration of resuscitation efforts before considering TOR; (2) Before enrolling in an uDCDD protocol, physicians must ascertain that additional resuscitation efforts would be ineffective; (3) Inclusion in an uDCDD protocol should not be made in the outpatient setting to avoid error and conflicts of interest; (4) The patient’s condition should be reassessed at the hospital and reversible causes treated; (5) A no-touch period of at least 10 minutes should be respected to avoid the risk of autoresuscitation; (6) Once death has been determined, no procedure that may resume brain circulation should be used, including cardiopulmonary resuscitation, artificial ventilation, and extracorporeal membrane oxygenation; (7) Specific consent is required prior to entry into an uDCDD protocol; (8) Family members should be informed about the goals, risks, and benefits of planned uDCDD procedures; and (9) Public information on uDCDD is desirable because it promotes public trust and confidence in the organ donation system.

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