Advancing the Scientific Basis for Determining Death in Controlled Organ Donation After Circulatory Determination of Death

被引:1
|
作者
Murphy, Nicholas B. [1 ,2 ]
Shemie, Sam D. [3 ,4 ]
Capron, Alex [5 ,6 ]
Truog, Robert D. [7 ,8 ]
Nakagawa, Thomas [9 ]
Healey, Andrew [10 ,11 ,12 ]
Gofton, Teneille [13 ]
Bernat, James L. [14 ]
Fenton, Kathleen [15 ]
Khush, Kiran K. [16 ]
Schwartz, Bryanna [17 ,18 ]
Wall, Stephen P. [19 ,20 ]
机构
[1] Western Univ, Dept Med, London, ON, Canada
[2] Western Univ, Dept Philosophy, 1151 Richmond St, London, ON N6A 3K7, Canada
[3] McGill Univ, Montreal Childrens Hosp, Div Crit Care Med, Montreal, PQ, Canada
[4] Canadian Blood Serv, Syst Dev, Ottawa, ON, Canada
[5] Univ Southern Calif, Gould Sch Law, 699 Exposit Blvd, Los Angeles, CA 90089 USA
[6] Univ Southern Calif, Keck Sch Med, Los Angeles, CA USA
[7] Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA USA
[8] Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA USA
[9] Univ Florida, Coll Med Jacksonville, Dept Pediat, Div Pediat Crit Care Med, Jacksonville, FL USA
[10] Ontario Hlth Trillium Gift Life Network, Toronto, ON, Canada
[11] McMaster Univ, Dept Med, Div Emergency, Hamilton, ON, Canada
[12] McMaster Univ, Dept Med, Div Crit Care Med, Hamilton, ON, Canada
[13] Western Univ, Schulich Sch Med & Dent, Dept Clin Neurol Sci, London, ON, Canada
[14] Dartmouth Geisel Sch Med, Dept Neurol, Hanover, NH USA
[15] NHLBI, Adv Technol & Surg Branch, Div Cardiovasc Sci, Dept Bioeth,Clin Ctr,NIH, Bethesda, MD USA
[16] Stanford Univ, Sch Med, Dept Med, Div Cardiovasc Med, Stanford, CA USA
[17] NHLBI, Heart Dev & Struct Dis Branch, Div Cardiovasc Sci, NIH, Bethesda, MD USA
[18] Childrens Natl Hosp, Div Cardiol, Washington, DC USA
[19] NYU, Grossman Sch Med, Ronald O Perelman Dept Emergency Med, New York, NY USA
[20] NYU, Grossman Sch Med, Dept Populat Hlth, New York, NY USA
关键词
NORMOTHERMIC REGIONAL PERFUSION; LIFE-SUSTAINING THERAPY; LIVER-TRANSPLANTATION; CARDIAC DEATH; BRAIN-DEATH; WITHDRAWAL; TIME; PROCUREMENT; AUTORESUSCITATION; PERMANENCE;
D O I
10.1097/TP.0000000000005002
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
In controlled organ donation after circulatory determination of death (cDCDD), accurate and timely death determination is critical, yet knowledge gaps persist. Further research to improve the science of defining and determining death by circulatory criteria is therefore warranted. In a workshop sponsored by the National Heart, Lung, and Blood Institute, experts identified research opportunities pertaining to scientific, conceptual, and ethical understandings of DCDD and associated technologies. This article identifies a research strategy to inform the biomedical definition of death, the criteria for its determination, and circulatory death determination in cDCDD. Highlighting knowledge gaps, we propose that further research is needed to inform the observation period following cessation of circulation in pediatric and neonatal populations, the temporal relationship between the cessation of brain and circulatory function after the withdrawal of life-sustaining measures in all patient populations, and the minimal pulse pressures that sustain brain blood flow, perfusion, activity, and function. Additionally, accurate predictive tools to estimate time to asystole following the withdrawal of treatment and alternative monitoring modalities to establish the cessation of circulatory, brainstem, and brain function are needed. The physiologic and conceptual implications of postmortem interventions that resume circulation in cDCDD donors likewise demand attention to inform organ recovery practices. Finally, because jurisdictionally variable definitions of death and the criteria for its determination may impede collaborative research efforts, further work is required to achieve consensus on the physiologic and conceptual rationale for defining and determining death after circulatory arrest.
引用
收藏
页码:2197 / 2208
页数:12
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