, Volume 35, Issue 10, pp 1673-1677
Date: 10 Jul 2009

Cardiac death or circulatory arrest? Facts and values in organ retrieval after diagnosis of death by cardio-circulatory criteria

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Introduction

Transplantation is the most effective long-term treatment for end-stage disease of vital organs. Patients who are declared dead by either neurological or cardio-circulatory criteria are the most important source of organs. Donation after cardiac death (DCD) was the first source of cadaveric organs for transplantation. After the definition of brain death (BD) became accepted, and retrieving well-perfused organs from heart-beating brain-dead donors became possible, DCD was all but abandoned. It has now regained ground in the last 15 years because of a severe imbalance between the number of people dying while waiting for transplantation and the number of available organs.

Donation after cardiac death can take place in patients who die after unsuccessful CPR after unexpected cardiac arrest (non-controlled DCD, Maastricht class 1, 2 and 4) or after planned forgoing of artificial life support (controlled DCD, Maastricht class 3). Because of its particular bioethical aspects, in th