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Donation after cardiocirculatory death: A call for a moratorium pending full public disclosure and fully informed consent

Joffe, AR and Carcillo, J and Anton, N and deCaen, A and Han, YY and Bell, MJ and Maffei, FA and Sullivan, J and Thomas, J and 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, 6 (1).

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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. © 2011 Joffe et al; licensee BioMed Central Ltd.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Joffe, AR
Carcillo, Jjac22@pitt.eduJAC220000-0001-8920-4330
Anton, N
deCaen, A
Han, YY
Bell, MJ
Maffei, FA
Sullivan, J
Thomas, J
Garcia-Guerra, G
Date: 29 December 2011
Date Type: Publication
Journal or Publication Title: Philosophy, Ethics, and Humanities in Medicine
Volume: 6
Number: 1
DOI or Unique Handle: 10.1186/1747-5341-6-17
Schools and Programs: School of Medicine > Critical Care Medicine
School of Medicine > Pediatrics
Refereed: Yes
Article Type: Review
Date Deposited: 01 Nov 2016 17:57
Last Modified: 18 Nov 2020 19:55


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