1 Ethics Unit, University Hospital of Lausanne, Lausanne, Switzerland.
2 Institute for Biomedical Ethics, University Medical Center, Geneva, Switzerland.
J Intensive Care Med. 2018 Nov;33(11):624-634. doi: 10.1177/0885066616682200. Epub 2016 Dec 21.
Uncontrolled donation after circulatory determination of death (uDCDD) refers to organ donation after a refractory cardiac arrest. We analyzed ethical issues raised by the uDCDD protocols of France, Madrid, and New York City. We recommend: (1) Termination of resuscitation (TOR) guidelines need refinement, particularly the minimal duration of resuscitation efforts before considering TOR; (2) Before enrolling in an uDCDD protocol, physicians must ascertain that additional resuscitation efforts would be ineffective; (3) Inclusion in an uDCDD protocol should not be made in the outpatient setting to avoid error and conflicts of interest; (4) The patient's condition should be reassessed at the hospital and reversible causes treated; (5) A no-touch period of at least 10 minutes should be respected to avoid the risk of autoresuscitation; (6) Once death has been determined, no procedure that may resume brain circulation should be used, including cardiopulmonary resuscitation, artificial ventilation, and extracorporeal membrane oxygenation; (7) Specific consent is required prior to entry into an uDCDD protocol; (8) Family members should be informed about the goals, risks, and benefits of planned uDCDD procedures; and (9) Public information on uDCDD is desirable because it promotes public trust and confidence in the organ donation system.
脑死亡判定后无自主循环供体（uDCDD）是指在难治性心脏停搏后进行的器官捐献。我们分析了法国、马德里和纽约市的 uDCDD 方案所引发的伦理问题。我们建议：（1）终止复苏（TOR）指南需要细化，特别是在考虑 TOR 之前，复苏努力的最短持续时间；（2）在参加 uDCDD 方案之前，医生必须确定额外的复苏努力将无效；（3）不应在门诊环境中纳入 uDCDD 方案，以避免错误和利益冲突；（4）应在医院重新评估患者的病情，并治疗可逆性病因；（5）应至少遵守 10 分钟的无触摸期，以避免自动复苏的风险；（6）一旦确定死亡，不得使用可能恢复脑循环的任何程序，包括心肺复苏、人工通气和体外膜氧合；（7）在进入 uDCDD 方案之前需要获得特定的同意；（8）应告知家属计划进行的 uDCDD 程序的目标、风险和益处；（9）需要对 uDCDD 进行公众宣传，因为这可以促进公众对器官捐献系统的信任和信心。
