Transfusion medicine

The study find that the Donation before circulatory death for imminently dying patients has been proposed to address organ scarcity and harms of non donation. To characterize stakeholder attitudes about organ recovery before circulatory death we conducted semi structured interviews with family members (N = 15) who had experienced a loved one’s unsuccessful donation after circulatory death and focus groups with professional stakeholders (surgeons, anesthesiologists, critical care specialists, palliative care specialists, organ procurement personnel, and policymakers, N = 46).

Donation before circulatory

We then used qualitative content analysis to characterize these perspectives. Professional stakeholders believed that donation of all organs before circulatory death was unacceptable; morally repulsive; and equivalent to murder; consent for such a procedure would be impermissible. Respondents feared the social costs related to recovery before death were too high. Although beliefs about recovery of all organs were widely shared; some professional stakeholders could accommodate removal of a single kidney before circulatory death.

In contrast, family members were typically accepting of donation before circulatory death for a single kidney; and many believed recovery of all organs was permissible because they believed the cause of death was the donor’s injury; not organ procurement. These findings suggest that definitions of death and precise rules around organ donation are critical for professional stakeholders; whereas donor families find less relevance in these constructs for determining the acceptability of organ donation. Donation of a single kidney before circulatory death warrants future exploration.

The cause of death

Disparity between organs available for transplant and patients with end-stage organ disease results in 20 transplant waitlist deaths daily.  Although living donation can meet some needs, most patients rely on organ recovery from a deceased donor. Because not all individuals with severe brain injury will meet death by neurologic criteria; organ recovery in compliance with the dead-donor rule can proceed only if the donor’s heart stops beating after withdrawal of mechanical support within a specific time frame. Failure to die in time precludes the procurement procedure and leads to loss of organs. We previously described family member experiences of unsuccessful donation and characterized multiple harms; including waste of precious resources, disrupted bereavement; and inability to honor the donor.

[5] Given these harms and the corollary benefits of successful donation, we sought to investigate perspectives about innovative donation strategies from multiple key stakeholders including donor families, medical teams and other organ transplant professionals. Donation before circulatory death is a proposal that could address the failure to recover organs from all enthusiastic donors. This strategy would permit organ recovery prior to withdrawal of life sustaining treatments and provide an opportunity for patients with severe neurologic injury to donate.