Health Care Ethics
McAnulty College and Graduate School of Liberal Arts
Peter Ikechukwu Osuji
Organ Donation, Transplantation, Extracorporeal Interval Support, Circulatory Determination of Death, Ethics, End of Life Care, Paliative Care
THE ETHICAL JUSTIFICATION OF EXTRACORPOREAL INTERVAL SUPPORT FOR ORGAN RETRIEVAL (EISOR) WITHIN THE CONTEXT OF DONATION AFTER CIRCULATORY DETERMINATION OF DEATH (DCDD)
Donation after Circulatory Determination of Death (DCDD) protocol contributes to the increase in the number of organs available for transplant. However, the primary practical limitation of the DCDD practice is that the retrieved organs are not of good quality. The organs retain long periods of warm ischemia between the cardio-circulatory arrest of donors and the cold preservation of the donated organs. Within the period, ischemic damage affects the organs, leading to the graft's primary non-function or delayed-graft function. The graft's primary non-function or delayed-graft procedure means that a donor's organs' suitability for transplantation has declined rapidly. The decline is a result of the warm ischemic condition after cardiac death.
There is an agreement among experts that it is necessary to make the warm ischemic time as short as possible to prevent or minimize the damage. However, reducing warm ischemic time indiscriminately has both legal and ethical consequences. Alternatively, some clinicians figured out that to perfuse oxygenated blood into the donor organ after the cardiac declaration of death until organ procurement is a safe remedy.
We established that EISOR assisted DCDD protocol restores the flow of warm oxygenated blood in the absence of cardiac activity during the interval between death and organ procurement. By doing so, EISOR-assisted DCDD protocol protects the vital organs from warm ischemic damage. EISOR-assisted DCDD can occur while abiding with the major ethical principles in healthcare.
Anyaeche, J. (2021). The Ethical Justification of Extracorporeal Interval Support for Organ Retrieval (EISOR) within the Context of Donation after Circulatory Determination of Death (DCDD) (Master's thesis, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1958
Available for download on Saturday, May 07, 2022