Defense Date

3-29-2021

Graduation Date

Spring 5-7-2021

Availability

One-year Embargo

Submission Type

thesis

Degree Name

DHCE

Department

Health Care Ethics

School

McAnulty College and Graduate School of Liberal Arts

Committee Chair

Gerard Magill

Committee Member

Joris Gielen

Committee Member

Peter Ikechukwu Osuji

Committee Member

Kristine Blair

Committee Member

Joris Gielen

Keywords

Organ Donation, Transplantation, Extracorporeal Interval Support, Circulatory Determination of Death, Ethics, End of Life Care, Paliative Care

Abstract

THE ETHICAL JUSTIFICATION OF EXTRACORPOREAL INTERVAL SUPPORT FOR ORGAN RETRIEVAL (EISOR) WITHIN THE CONTEXT OF DONATION AFTER CIRCULATORY DETERMINATION OF DEATH (DCDD)

ABSTRACT

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.

Language

English

Available for download on Saturday, May 07, 2022

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