TY - JOUR
T1 - Expanding controlled donation after the circulatory determination of death
T2 - statement from an international collaborative
AU - Domínguez-Gil, Beatriz
AU - Ascher, Nancy
AU - Capron, Alexander M.
AU - Gardiner, Dale
AU - Manara, Alexander R.
AU - Bernat, James L.
AU - Miñambres, Eduardo
AU - Singh, Jeffrey M.
AU - Porte, Robert J.
AU - Markmann, James F.
AU - Dhital, Kumud
AU - Ledoux, Didier
AU - Fondevila, Constantino
AU - Hosgood, Sarah
AU - Van Raemdonck, Dirk
AU - Keshavjee, Shaf
AU - Dubois, James
AU - McGee, Andrew
AU - Henderson, Galen V.
AU - Glazier, Alexandra K.
AU - Tullius, Stefan G.
AU - Shemie, Sam D.
AU - Delmonico, Francis L.
N1 - Publisher Copyright:
© 2021, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/3
Y1 - 2021/3
N2 - A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.
AB - A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.
KW - Determination of death
KW - Donation after the circulatory determination of death
KW - Normothermic regional perfusion
KW - Organ perfusion
KW - Organ repair
KW - Organ transplantation
KW - Tissue and organ procurement
KW - Withdrawal of life-sustaining therapy
UR - http://www.scopus.com/inward/record.url?scp=85101384967&partnerID=8YFLogxK
U2 - 10.1007/s00134-020-06341-7
DO - 10.1007/s00134-020-06341-7
M3 - Article
C2 - 33635355
AN - SCOPUS:85101384967
SN - 0342-4642
VL - 47
SP - 265
EP - 281
JO - Intensive care medicine
JF - Intensive care medicine
IS - 3
ER -