The unique moral permissibility of uncontrolled lung donation after circulatory death.
Brendan ParentArthur CaplanLuis AngelZachary KonNancy DublerLewis GoldfrankJacob LindnerStephen P WallPublished in: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (2019)
Implementing uncontrolled donation after circulatory determination of death (uDCDD) in the United States could markedly improve supply of donor lungs for patients in need of transplants. Evidence from US pilot programs suggests families support uDCDD, but only if they are asked permission for using invasive organ preservation procedures prior to initiation. However, non-invasive strategies that confine oxygenation to lungs may be applicable to the overwhelming majority of potential uDCDD donors that have airway devices in place as part of standard resuscitation. We propose an ethical framework for lung uDCDD by: (a) initiating post mortem preservation without requiring prior permission to protect the opportunity for donation until an authorized party can be found; (b) using non-invasive strategies that confine oxygenation to lungs; and (c) maintaining strict separation between the healthcare team and the organ preservation team. Attempting uDCDD in this way has great potential to obtain more transplantable lungs while respecting donor autonomy and family wishes, securing public support, and enabling authorized persons to affirm or cease preservation decisions without requiring evidence of prior organ donation intent. It ensures prioritization of life-saving, the opportunity to allow willing donors to donate, and respect for bodily integrity while adhering to current ethical norms.
Keyphrases
- healthcare
- end stage renal disease
- palliative care
- quality improvement
- chronic kidney disease
- cardiac arrest
- ejection fraction
- newly diagnosed
- extracorporeal membrane oxygenation
- public health
- decision making
- peritoneal dialysis
- blood flow
- prognostic factors
- randomized controlled trial
- mental health
- emergency department
- risk assessment
- study protocol
- clinical trial
- human health
- high resolution
- drug induced
- patient reported