Medical standards are aligned with normothermic regional perfusion practices and US legal standards for determining death
Year: 2022
Type: editorial
Abstract: To the Editor: Glazier and Capron1 argue that normothermic regional perfusion (NRP) donation after circulatory death (DCD) protocols are not aligned with the Uniform Determination of Death Act (UDDA)2 and that the intention of physicians and patients is absent from the legal determination of death in the United States. This editorial provides a dangerously conservative interpretation of the UDDA that not only brings into question death in the setting of NRP DCD but also death in the setting of standard DCD protocols and perhaps any determination of death based on cardiopulmonary criteria. Glazier and Capron's contention that death can only be declared when circulation cannot and will not return regardless of intent ignores a critical portion of the UDDA—that the determination of death must be made in accordance with accepted medical standards. Accepted medical standards require intent to allow for natural death when the patient or family has made the decision to withdraw life-sustaining treatments and implemented a do not resuscitate order. If the legal determination of death requires that circulation cannot resume regardless of intention, this interpretation of the UDDA is problematic for all DCD organ procurements as well as the over 90% of hospitalized patients who are declared dead using cardiopulmonary criteria, as most could be resuscitated to the point of resumed cardio-pulmonary function with CPR, ECMO, or other interventions. Unlike the scenarios in which circulation is not resumed because resuscitative efforts are not made, Glazier and Capron have previously expressed concern that the resumption of circulatory function of the heart during NRP DCD procedures negates the prior declaration of death by invalidating the conditions under which death was declared.3 The resumption of the circulatory function of the heart is not exclusive to NRP DCD procedures. After super rapid recovery (SRR) DCD cardiac procurement, the donor's heart is restarted on an external perfusion device that connects into the heart. In NRP DCD procedures, the donor's heart is restarted in the body using an external perfusion device that is connected to the donor's blood vessels. While there is a difference in the location where the heart is restarted in NRP DCD and SRR DCD, there is no substantive difference in the fact that the circulatory function of the heart can be restarted after the declaration of death without negating that declaration. Ultimately, the legal definition of death must be in line with the standards of medical practice and respond to new medical technologies. NRP DCD procurements can utilize medical technology after death for organ preservation without negating medical standards for the declaration of death, and therefore remains consistent with the UDDA. Part of respecting the legacy of the decedent and providing family closure is to make organ donation an option, and to make organ transplantation as likely as possible when the choice has been made to donate. Adopting this conservative interpretation of the UDDA will lead not only to paralysis of DCD organ donation but also to the current practices of determining death using cardiopulmonary criteria.
DOI: 10.1111/ajt.17114
Authors: Anji Wall, Giuliano Testa, Stephen Wall, Seth Karp
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W4281748429