Patuzzo Manzati Sara, Galeone Antonella, Onorati Francesco, Luciani Giovanni Battista
Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of History of Medicine and Bioethics, University of Verona, Piazzale A. Stefani 1, 37129, Verona, Italy.
Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Piazzale A. Stefani 1, 37129, Verona, Italia.
J Bioeth Inq. 2025 Jun;22(2):257-264. doi: 10.1007/s11673-024-10382-8. Epub 2024 Sep 5.
A fundamental criterion considered essential to deem the procedure of vital organ procurement for transplantation ethical is that the donor must be dead, as per the Dead Donor Rule (DDR). In the case of Donation after Circulatory Death (DCD), is the donor genuinely dead? The main aim of this article is to clarify this uncertainty, which primarily arises from the fact that in DCD, death is determined based on cardiac criteria (Circulatory Death, CD), rather than neurological criteria (Brain Death, BD), and that to allow the procurement procedure, physicians reperfuse the organs in an assisted manner. To ensure that the cessation of circulation leads to the irreversible loss of brain functions, DCD regulations require that physicians wait a certain period after CD before commencing vital organ procurement. However, during this "no-touch period," the organs are at risk of damage, potentially rendering them unsuitable for transplantation. When DCD is performed on patients whose CD follows a Withdrawal of Life-Sustaining Treatment (WLST) (DCD Maastricht III category), how long should the no-touch period last? Does its existence really make sense? Does beginning the procedure of vital organ procurement immediately after WLST constitute a violation of the DDR that can be ethically justified? The discussion aims to provide arguments in support of the non-absoluteness of the DDR.
根据死亡供体规则（DDR），认为移植用重要器官获取程序符合伦理的一个基本标准是供体必须已经死亡。在循环死亡后捐赠（DCD）的情况下，供体真的死亡了吗？本文的主要目的是澄清这种不确定性，这种不确定性主要源于以下事实：在DCD中，死亡是根据心脏标准（循环死亡，CD）而非神经学标准（脑死亡，BD）来判定的，并且为了进行获取程序，医生会以辅助方式对器官进行再灌注。为确保循环停止导致脑功能不可逆转地丧失，DCD规定要求医生在CD后等待一定时间再开始重要器官的获取。然而，在这个“无干预期”，器官有受损的风险，这可能使它们不适用于移植。当对在撤除维持生命治疗（WLST）后出现CD的患者进行DCD（DCD马斯特里赫特III类）时，无干预期应该持续多长时间？它的存在真的有意义吗？在WLST后立即开始重要器官获取程序是否构成违反DDR但在伦理上可以被证明合理的行为？该讨论旨在提供支持DDR并非绝对的论据。
