Alpert Medical School of Brown University, Providence, RI 02903, USA.
Am J Bioeth. 2012;12(6):1-8. doi: 10.1080/15265161.2012.671886.
Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor's death, this approach satisfies the dead donor rule. The donor family's wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives.
心脏死亡后捐献（DCD）存在许多问题，包括缺血损伤、移植物功能延迟发生率高以及频繁器官废弃。此外，许多潜在的 DCD 供者未能以安全进行器官移植的方式进展至心脏停搏，导致无器官可回收。DCD 方案基于以下原则：在器官回收前必须先宣布供者死亡。提出了一项新的方案，即在供者家属同意停止生命支持治疗后，在生命终末期管理之前预先进行生前肾切除术。由于肾切除术不应导致供者死亡，因此这种方法符合死亡供者规则。通过器官捐献、受者获得成功的结果以及死者尊严的死亡，最好地满足了供者家属的意愿。这一提议提高了实现这些目标的可能性。
