Ethical and Organizational Issues in Adopting a Pediatric Protocol for Controlled Donation After Circulatory Determination of Death

Abstract

Despite two decades of ethical and clinical debate, controlled donation after circulatory determination of death (cDCDD) remains a controversial practice, especially in pediatrics. While debates continue both nationally and internationally, it can be challenging for pediatric hospitals to build agreement on a cDCDD policy among their own constituents. After briefly reviewing the state of the larger debates, this chapter describes organizational steps involved in developing a cDCDD policy for one deeply divided pediatric hospital community. Tracing the experience of a large, tertiary-care teaching hospital and transplant center, the chapter reports the work of a multidisciplinary task force that developed an empirical evidence base and an ethical "constitution" for a cDCDD program, as well as a protocol for pediatric cDCDD. The chapter highlights a number of philosophical and practical issues considered in this process, including questions about the compatibility of a cDCDD program with the overall mission of the hospital. Also described are organizational measures aimed at forging a transparent, legitimate policy in a context of partial stakeholder agreement and persistent controversy.