Elsevier

The Lancet

Volume 379, Issue 9823, 7–13 April 2012, Pages 1275-1276
The Lancet

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Protocols for uncontrolled donation after circulatory death

https://doi.org/10.1016/S0140-6736(11)61784-4Get rights and content

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    Therefore, the declaration of death and the ability to initiate organ preservation maneuvers after 5 min of cardiorespiratory arrest in cDCD, in particular, are predicated on a condition of “permanence”: that permanent loss of circulation to the brain and brainstem will not be reversed and will inevitably lead to irreversible loss of circulation (i.e., brain death) [23]. In spite of the fact that it is limited to the abdomen and occasionally the chest, some authors feel that establishment of NRP negates the condition of permanence and the diagnosis of death [24,25]. While views vary according to region and ethos, it is undeniable that clear and effective measures have to always be enacted to ensure lack of flow to the aortic arch vessels during NRP, thereby maintaining the permanence of circulatory arrest in the brain and brainstem and allowing brain death to progress [26].

  • Kidney transplantation from donors after uncontrolled circulatory death: the Spanish experience

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    Additional programs have been implemented in other countries, although the numbers of donors reported are modest.2 The most important reasons for the limited expansion of uDCD is the absence of a dedicated legal framework or the legal prohibition of this practice in certain countries, as well as several ethical concerns.30–32 These legal and ethical barriers have been confronted in Spain in a specific manner detailed in the national regulatory framework, which sets the basis for the general protocol described in this article.8,9

  • An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest

    2018, Resuscitation
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    ECPR and uDCDD have limited current integration secondary to high resource and training requirements [21] and limited development of uDCDD programs. When both uDCDD and ECPR are available for rCA patients, uDCDD should only be deployed if ECPR is contraindicated or futile [22,23]. Experience integrating these two techniques is lacking and opportunities for organ procurement are therefore missed [24].

  • Organ donation protocols

    2017, Handbook of Clinical Neurology
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    Advances in medicine, particularly in the field of resuscitation, blur the fine line between a potential organ donor and a potential survivor, thus challenging the DDR and unveiling a possible conflict of interest in implementing organ-preserving measures instead of continuing life-saving interventions. Centering clinical efforts on the latter until those are exhausted and exploring donation options only afterwards would alleviate this conflict of interest, in addition to earning public confidence (Doig and Zygun, 2008; Manara and Thomas, 2010; Hanto and Veatch, 2011; Rodriguez-Arias and Deballon, 2012; Rodriguez-Arias et al., 2013; Reed and Lua, 2014). The heterogeneity of views and protocols in cDCD and uDCD is a reflection of the complexity of this process, which involves delicate ethical nuances and controversies.

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