Controlled Donation After Cardiac Death in Pediatrics

Abstract

Donation after circulatory death (DCD) is a relatively new topic in pediatric ethics. This chapter explores the ethical dimensions of controlled DCD, first examining the distinction between donation following brain death and donation following controlled circulatory death. While uncontrolled donation following circulatory death increases, a detailed consideration of the unique issues in that setting is beyond the scope of this chapter. We describe the background of and challenges to the dead donor rule, including debate over whether it comprises the appropriate ethical or legal basis for organ donation. With respect to donation in pediatrics, we examine the DCD process from the standpoint of multiple stakeholders, including parents/ family members, clinicians, and organ procurement organizations. Finally, we explore the role of national and organizational regulations and guidelines in systematically addressing ethical issues with DCD practices. This discussion gives special attention to parental involvement and consent. Lastly, we consider the role for DCD protocols as additional mechanisms to manage the many ethical issues that arise with pediatric DCD.