Controversies in Organ Donation: Donation After Cardiac Death

An ever-increasing disparity between the demand for vital organs for transplantation and the number of available donors presents challenges to the medical community. Persistent barriers to donation include public concerns regarding definitions of death; concerns regarding potential conflicts of interest; and worries that end-of-life care may be compromised. Strategies to increase the number of eligible donors have included the development of brain-death criteria and donation after cardiac death (DCD) protocols. DCD combines the elective withdrawal of life-sustaining therapy, followed by organ donation. DCD meets desired ethical goals, but creates potential for ethical conflicts, errors, and harm. Two particularly problematic issues are the administration of medications to the dying patient that might hasten death, and redefining the moment of death to facilitate organ donation.