Controlled Donation After Circulatory Determination of Death: Ethical Issues in Withdrawing Life-Sustaining Therapy

A.L. Dalle Ave, David Shaw

Research output: Contribution to journalReview articlepeer-review

Abstract

Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of cDCDD protocols and the ethical literature. Our analysis confirms that W-LST procedures vary considerably among cDCDD centers and that despite existing recommendations, the conflict of interest in the W-LST decision and process might be difficult to avoid, the process of W-LST might interfere with usual end-of-life care, and there is a risk of hastening death. In order to ensure that
the practice of W-LST meets already well-established ethical recommendations, we suggest that W-LST should be managed in the ICU by an ICU physician who has been part of the W-LST decision. Recommending extubation for W-LST, when this is not necessarily the preferred procedure, is inconsistent with the recommendation to follow usual W-LST protocol. As the risk of conflicts of interest in the decision of W-LST and in the process of W-LST exists, this should be acknowledged and disclosed. Finally, when cDCDD programs interfere with W-LST and end-of-life care, this should be transparently disclosed to the family,
and specific informed consent is necessary.
Original languageEnglish
Pages (from-to)179-186
Number of pages8
JournalJournal of Intensive Care Medicine
Volume32
Issue number3
DOIs
Publication statusPublished - Mar 2017

Keywords

  • transplantation
  • ethics
  • controlled donation after circulatory determination of death
  • withdrawal of life-sustaining therapy
  • BEATING ORGAN DONATION
  • CARDIAC DEATH
  • CRITICAL-CARE
  • EXTRACORPOREAL SUPPORT
  • LIVER-TRANSPLANTATION
  • DONORS
  • HEART
  • PROCUREMENT
  • END
  • MEDICINE

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