The ethics of organ donation after cardiocirculatory death: Do the guidelines of the Canadian Council for Donation and Transplantation measure up?

摘要: The practice of transplantation the world over is governed by dead donor rule: non-paired vital organs can be retrieved only from patients who are dead. It therefore important to have clear criteria for determination death. Most transplantable come declared neurologic criteria. These called heart-beating donors; they suffered a catastrophic brain injury, been ventilated, and had their functions maintained mechanically up point at which death then beyond, until retrieved. pool expanded permitting an alternative form donation known as after cardiocirculatory (DCD), or non-heart-beating organ transplantation. donors in this case whom there no hope recovery but not dying because injury hence will suffer necessary them become donors. DCD has accepted medical internationally 15 years1 came Canada 2006, when Canadian Council Donation Transplantation (CCDT) published its national recommendations.2 Countries that permit DCD variable success increasing supply organs. kidneys, with CCDT recommends centres begin programs,2 serves good example. In 2003, kidneys donated accounted 4% total transplanted both Spain, highest per capita rate any organs, United States, number transplants. By contrast, Netherlands, was leader DCD, 39% country’s kidney transplants.3* effect introducing into uncertain, Doig Rocker estimate “could contribute increase solid including 20% more other liver, pancreas pancreatic islet cells.”4 The that, purposes diagnosed 5 minutes continuously observed absence pulse, blood pressure respiration life support discontinued.2 This recommendation 5-minute interval coincides Institute Medicine5 commonly North America Kingdom. However, it falls short time frame “at least 10 proven lack circulation brain” estimated report US President’s Commission Study Ethical Problems Medicine Biomedical Behavioral Research.6 also universally lies between alternatives include 75-second advocated Boucek colleagues,7 2-minute used Pittsburgh some UK centres2 10-minute still St. Michael’s Hospital Toronto.8 In guidelines, aimed “promote patient-care-based principles providing option within sound ethical framework provide guidance individual programs developing parameters safe field.”2 We measure achieving aim considering two questions most often asked families thinking about DCD: “Is my loved one really dead?” “Will he she feel pain?”9 reasonable suppose acceptable program either enable health care professional answer those unequivocal “Yes” first instance “No” second or, if not, give information need make informed decision donation. article, I argue follows recommendations do neither these things satisfy ordinary consent requirements.