Organ donation after cardiac death (DCD) differs from organ donation after brain death (DBD) insofar that DCD donors are alive and donate organs after discontinuation of life support so that a natural death may occur, followed by extraction of organs. This increases the availability of transplantable organs. According to the Health Resources and Services Administration, 5,896 donations, representing 36% of all donations in 2023, were DCD, representing an increase of 40.7% over the preceding 3 years. There are significant ethical and scientific issues in the performance of DCD.

Issues in DCD

Lack of informed consent/authorization: Although DBD is usually authorized by enlisting in a national or state driver’s licensing database, it is likely that DCD has never been authorized or consented to by any patient.

Lack of scientific basis for irreversibility

In DBD, there is a distinct line drawn between life and death enabling organ extraction for donation to proceed. Sometimes, patients will recover from the DCD process.

Likelihood of abuse

In the face of an entire OR team waiting impatiently to begin organ extraction, the physician is likely to face pressure to accelerate the process by administering drugs in dosages beyond those needed to assure comfort, ie. euthanasia.

Confusion of roles

Participation in DCD creates a conflict of interest. Doctors and the ICU care team are responsible only to the patient and family and not to anyone else, even to potential organ recipients.

Dignity and quality of the dying process

In DCD, the discontinuation of life support against the time demands of securing viable organs is likely to interfere with the palliative care of the patient during the dying process. This is an issue with most, if not all, DCD attempts.

If DCD is performed, it must be pursued with compassion and respect, to always obtain primary emphases on the patient’s dignity and comfort