The circulatory-respiratory determination of death in organ donation

James L. Bernat, Alexander M. Capron, Thomas P. Bleck, Sandralee Blosser, Susan L. Bratton, James F. Childress, Michael A. Devita, Gerard J. Fulda, Cynthia J. Gries, Mudit Mathur, Thomas A. Nakagawa, Cynda Hylton Rushton, Sam D. Shemie, Douglas B. White

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

Objective: Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory-respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory-respiratory death determination. We studied circulatory-respiratory death determination to clarify its concept, practice, and application to innovative circulatory determination of death protocols. Results: It is ethically and legally appropriate to procure organs when permanent cessation (will not return) of circulation and respiration has occurred but before irreversible cessation (cannot return) has occurred because permanent cessation: 1) is an established medical practice standard for determining death; 2) is the meaning of "irreversible" in the Uniform Determination of Death Act; and 3) does not violate the "Dead Donor Rule." Conclusions: The use of unmodified extracorporeal membrane oxygenation in the circulatory determination of death donor after death is declared should be abandoned because, by restoring brain circulation, it retroactively negates the previous death determination. Modifications of extracorporeal membrane oxygenation that avoid this problem by excluding brain circulation are contrived, invasive, and, if used, should require consent of surrogates. Heart donation in circulatory determination of death is acceptable if proper standards are followed to declare donor death after establishing the permanent cessation of circulation. Pending additional data on "auto-resuscitation," we recommend that all circulatory determination of death programs should utilize the prevailing standard of 2 to 5 mins of demonstrated mechanical asystole before declaring death.

Original languageEnglish (US)
Pages (from-to)963-970
Number of pages8
JournalCritical care medicine
Volume38
Issue number3
DOIs
StatePublished - Jan 1 2010

Fingerprint

Tissue and Organ Procurement
Extracorporeal Membrane Oxygenation
Tissue Donors
Brain
Physicians
Heart Arrest
Resuscitation

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Bernat, J. L., Capron, A. M., Bleck, T. P., Blosser, S., Bratton, S. L., Childress, J. F., ... White, D. B. (2010). The circulatory-respiratory determination of death in organ donation. Critical care medicine, 38(3), 963-970. https://doi.org/10.1097/CCM.0b013e3181c58916
Bernat, James L. ; Capron, Alexander M. ; Bleck, Thomas P. ; Blosser, Sandralee ; Bratton, Susan L. ; Childress, James F. ; Devita, Michael A. ; Fulda, Gerard J. ; Gries, Cynthia J. ; Mathur, Mudit ; Nakagawa, Thomas A. ; Rushton, Cynda Hylton ; Shemie, Sam D. ; White, Douglas B. / The circulatory-respiratory determination of death in organ donation. In: Critical care medicine. 2010 ; Vol. 38, No. 3. pp. 963-970.
@article{14c142fd038743788bb066a1487d25fb,
title = "The circulatory-respiratory determination of death in organ donation",
abstract = "Objective: Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory-respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory-respiratory death determination. We studied circulatory-respiratory death determination to clarify its concept, practice, and application to innovative circulatory determination of death protocols. Results: It is ethically and legally appropriate to procure organs when permanent cessation (will not return) of circulation and respiration has occurred but before irreversible cessation (cannot return) has occurred because permanent cessation: 1) is an established medical practice standard for determining death; 2) is the meaning of {"}irreversible{"} in the Uniform Determination of Death Act; and 3) does not violate the {"}Dead Donor Rule.{"} Conclusions: The use of unmodified extracorporeal membrane oxygenation in the circulatory determination of death donor after death is declared should be abandoned because, by restoring brain circulation, it retroactively negates the previous death determination. Modifications of extracorporeal membrane oxygenation that avoid this problem by excluding brain circulation are contrived, invasive, and, if used, should require consent of surrogates. Heart donation in circulatory determination of death is acceptable if proper standards are followed to declare donor death after establishing the permanent cessation of circulation. Pending additional data on {"}auto-resuscitation,{"} we recommend that all circulatory determination of death programs should utilize the prevailing standard of 2 to 5 mins of demonstrated mechanical asystole before declaring death.",
author = "Bernat, {James L.} and Capron, {Alexander M.} and Bleck, {Thomas P.} and Sandralee Blosser and Bratton, {Susan L.} and Childress, {James F.} and Devita, {Michael A.} and Fulda, {Gerard J.} and Gries, {Cynthia J.} and Mudit Mathur and Nakagawa, {Thomas A.} and Rushton, {Cynda Hylton} and Shemie, {Sam D.} and White, {Douglas B.}",
year = "2010",
month = "1",
day = "1",
doi = "10.1097/CCM.0b013e3181c58916",
language = "English (US)",
volume = "38",
pages = "963--970",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

Bernat, JL, Capron, AM, Bleck, TP, Blosser, S, Bratton, SL, Childress, JF, Devita, MA, Fulda, GJ, Gries, CJ, Mathur, M, Nakagawa, TA, Rushton, CH, Shemie, SD & White, DB 2010, 'The circulatory-respiratory determination of death in organ donation', Critical care medicine, vol. 38, no. 3, pp. 963-970. https://doi.org/10.1097/CCM.0b013e3181c58916

The circulatory-respiratory determination of death in organ donation. / Bernat, James L.; Capron, Alexander M.; Bleck, Thomas P.; Blosser, Sandralee; Bratton, Susan L.; Childress, James F.; Devita, Michael A.; Fulda, Gerard J.; Gries, Cynthia J.; Mathur, Mudit; Nakagawa, Thomas A.; Rushton, Cynda Hylton; Shemie, Sam D.; White, Douglas B.

In: Critical care medicine, Vol. 38, No. 3, 01.01.2010, p. 963-970.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The circulatory-respiratory determination of death in organ donation

AU - Bernat, James L.

AU - Capron, Alexander M.

AU - Bleck, Thomas P.

AU - Blosser, Sandralee

AU - Bratton, Susan L.

AU - Childress, James F.

AU - Devita, Michael A.

AU - Fulda, Gerard J.

AU - Gries, Cynthia J.

AU - Mathur, Mudit

AU - Nakagawa, Thomas A.

AU - Rushton, Cynda Hylton

AU - Shemie, Sam D.

AU - White, Douglas B.

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Objective: Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory-respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory-respiratory death determination. We studied circulatory-respiratory death determination to clarify its concept, practice, and application to innovative circulatory determination of death protocols. Results: It is ethically and legally appropriate to procure organs when permanent cessation (will not return) of circulation and respiration has occurred but before irreversible cessation (cannot return) has occurred because permanent cessation: 1) is an established medical practice standard for determining death; 2) is the meaning of "irreversible" in the Uniform Determination of Death Act; and 3) does not violate the "Dead Donor Rule." Conclusions: The use of unmodified extracorporeal membrane oxygenation in the circulatory determination of death donor after death is declared should be abandoned because, by restoring brain circulation, it retroactively negates the previous death determination. Modifications of extracorporeal membrane oxygenation that avoid this problem by excluding brain circulation are contrived, invasive, and, if used, should require consent of surrogates. Heart donation in circulatory determination of death is acceptable if proper standards are followed to declare donor death after establishing the permanent cessation of circulation. Pending additional data on "auto-resuscitation," we recommend that all circulatory determination of death programs should utilize the prevailing standard of 2 to 5 mins of demonstrated mechanical asystole before declaring death.

AB - Objective: Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory-respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory-respiratory death determination. We studied circulatory-respiratory death determination to clarify its concept, practice, and application to innovative circulatory determination of death protocols. Results: It is ethically and legally appropriate to procure organs when permanent cessation (will not return) of circulation and respiration has occurred but before irreversible cessation (cannot return) has occurred because permanent cessation: 1) is an established medical practice standard for determining death; 2) is the meaning of "irreversible" in the Uniform Determination of Death Act; and 3) does not violate the "Dead Donor Rule." Conclusions: The use of unmodified extracorporeal membrane oxygenation in the circulatory determination of death donor after death is declared should be abandoned because, by restoring brain circulation, it retroactively negates the previous death determination. Modifications of extracorporeal membrane oxygenation that avoid this problem by excluding brain circulation are contrived, invasive, and, if used, should require consent of surrogates. Heart donation in circulatory determination of death is acceptable if proper standards are followed to declare donor death after establishing the permanent cessation of circulation. Pending additional data on "auto-resuscitation," we recommend that all circulatory determination of death programs should utilize the prevailing standard of 2 to 5 mins of demonstrated mechanical asystole before declaring death.

UR - http://www.scopus.com/inward/record.url?scp=77249124847&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77249124847&partnerID=8YFLogxK

U2 - 10.1097/CCM.0b013e3181c58916

DO - 10.1097/CCM.0b013e3181c58916

M3 - Article

VL - 38

SP - 963

EP - 970

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 3

ER -