A Catholic Perspective on Organ Donation After Cardiac Death

Abstract

One alternative to increase the supply of human organs for transplantation being re-examined, especially for kidney transplants, is the use of the donation after cardiac death [DCD] criteria. DCD is defined as the surgical recovery of organs after the pronouncement of death based on cessation of cardiopulmonary function. Patients who meet the DCD criteria are either severely ill on life support, and life support can be withdrawn with proper consent, or they have suffered unexpected cardiac arrest, whether previously ill or not, and cannot be resuscitated. The major concerns among medical professionals are threefold: first, circumventing the brain death criteria; second, the administration of anticoagulants and vasodilators that have the possibility of hastening death; and third, concern about the time requirement for the declaration of death which ranges from 2 to 10 min of asystole or electromechanical disassociation. In contrast to these concerns, patients and surrogates making end-of-life decisions of withdrawal of life-support systems due to devastating traumas or critical illnesses are requesting such donations to comply with authorized advance directives. The shortage of organs available, especially kidneys, and the rising interest of the American public in organ transplantation, has led to the reexamination of DCD as a potential source of organ donation. Many organ procurement organizations have approached the Institutional Ethics Committees (IEC) of acute care facilities with an assortment of DCD protocols requesting implementation. However, before acute care facilities can agree to implement a DCD protocol, the serious medical and ethical questions raised from both the public and medical sectors of society must be addressed.