The unique moral permissibility of uncontrolled lung donation after circulatory death. Issue 2 (18th October 2019)

• Record Type: Journal Article
• Authors: Parent, Brendan; Caplan, Arthur; Angel, Luis; Kon, Zachary; Dubler, Nancy; Goldfrank, Lewis; Lindner, Jacob; Wall, Stephen P.
• Is Part Of: American journal of transplantation. Volume 20:Issue 2(2020)
• Page Start: 382
• Page End: 388
• Publication Date: 2019-10-18
• Subjects: donors and donation: donation after circulatory death (DCD) -- donors and donation: extended criteria -- editorial/personal viewpoint -- ethics and public policy -- lung transplantation/pulmonology -- organ procurement -- organ procurement and allocation; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15603
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : 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. Abstract : The authors propose an ethical framework for lung uncontrolled donation after circulatory determination of death in countries having opt‐out organ donation systems.