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Table 6 Consensus statements regarding donation after cardiocirculatory death from prominent medical groups, and some comments.

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

Consensus Group Funding Stated Goal Examples of concerns
National Conference on DCD, 2006 [3] Transplant organizations "To address the increasing experience of DCD and to affirm the ethical propriety of transplanting organs from such donors...[and] to expand the practice of DCD in the continuum of quality end-of-life care." 1. "By new developments not previously reported, the conference resolved controversy regarding the period of circulatory cessation that determines death and allows administration of pre-recovery pharmacologic agents." These new developments were not described nor referenced.
2. Claim there are two different mutually exclusive types of death such that "the cardiopulmonary criterion may be used when the donor does not fulfill brain death criteria."
Interdisciplinary panel, 2010 [5] Transplant organization "To re-examine the standards for death determination and to analyze the new protocols' compliance with these standards." 1. Claim that death is "fundamentally a medical practice issue and not primarily a moral or ontological issue [[40]p1762]."
2. Claim that permanent cessation of circulation "is the meaning of 'irreversible' in the Uniform Determination of Death Act." Therefore, it "is ethically and legally appropriate to procure organs when permanent cessation of circulation has occurred but before irreversible cessation." Yet, the lead authors previously wrote that 'permanent' is not compatible with the intent of the UDDA [41, 42].
Institute of Medicine, 1997 [1] Transplant organization "This report examines medical and ethical issues in recovering organs from NHBDs who do not meet the standard of brain death." 1. Accepted the premise "at the outset [that] recovery of organs from NHBDs should be considered a reasonable source of organs whose potential deserves serious exploration... It can be concluded, therefore, that the recovery of organs from NHBDs is an important, medically effective and ethically acceptable approach to closing the gap...[p45-46]"
2. The meaning or irreversible "must rest on expert medical opinion [p59]."
3. Ethical issues were presented to the IOM staff by "the chair of the committee that developed the Pittsburgh protocol for NHBDs in 1992 [p85]." The project heard presentations from those representing "medical and surgical transplantation, organ procurement, the bioethics of transplantation, donors, recipients, and the federal government [p45]."
Institute of Medicine, 2000 [123] Transplant organization "An effort designed to facilitate the adoption by all OPOs of protocols regarding NHBD." 1. Did not re-address the determination of death. Affirmed two different types of death: "the UDDA specifies the irreversible loss of all brain function or the irreversible cessation of cardiopulmonary function, not both [p24]."
Institute of Medicine, 2006 [75] Transplant organization "To study the issues involved in increasing the rates of organ donation." 1. Did not re-address the determination of death. Claimed that 'permanent' is "a reasonable interpretation of the concept of 'irreversibility' and is compatible with the probable intentions of the Commission that formulated the UDDA definition and with the UDDA's reference to 'accepted medical standards' [p172]."
2. Suggested uncontrolled DCD with reinstitution of CPR/ECMO, and supporting adopting the organ donation breakthrough collaborative, and suggested adopting "steps for preparation for such donation to the end of their [American Heart Association] standard resuscitation protocols [p185]."
3. A national workshop including "care providers, organ procurement professionals, and families who supported non-heart-beating donation [p2]."
SCCM Ethics Committee, 2001 [2] Unclear "To comment on the issues of timing of death." 1. Suggest a long observation time for certification of all deaths "flies in the face of both logic and the contemporary notion of death certification [p1872]." However, they did not discuss that in the context of DCD, and unlike in the 'routine' death diagnosis, following the dead donor rule requires knowing whether the patient is merely dying or already dead; diagnostic errors are not allowed, a retrospective diagnosis is not possible, and the long time of observation is required..
2. "Did not achieve unanimity regarding the single 'best' observation period for asystole, apnea, and unresponsiveness."
Canadian Forum, 2006 [4] Transplant organization "To inform and guide health care professionals involved in developing programs for DCD... Discussion at the forum was restricted to optimal and safe practice in the field as it pertains to DCD." 1. Presentations were heart "by experts from international jurisdictions where DCD is currently practiced [pS2]." Adopted "a weaker interpretation" of irreversible, apparently simply echoing the IOM and SCCM reports.
2. Claim that "there has been speculation that a phenomenon known as autoresuscitation may exist."
3. Claimed that "based on animal studies and isolated human case reports electrical function of the brain ceases within 20s after circulatory arrest [pS8]," not acknowledging that this EEG activity reflects only the superficial cortical activity of cerebral hemispheres, not adequate to suggest brain death has occurred [58].