Donation after cardiac death in heart transplantation: is there an ethical dilemma?

Purpose of review In an attempt to address the organ shortages in heart transplantation, USA centres have begun utilizing donation after cardiac death (DCD) as an alternative to traditional donation after brain death (DBD). As this paradigm continues to expand, there is a need to address the medico-legal and ethical aspects of DCD donation, which is the focus of the current review. Recent findings Current protocols use criteria established by the Uniform Determination of Death Act (UDDA), which is explicit in defining the irreversibility of circulation and brain function in determining death. By the nature of DCD, the patient may not meet death criteria from a biological systems perspective of irreversibility, and thus, the moral dilemma ensues on whether removing vital organs violates our legal and moral obligations to the patient. In the current article, we review the ethical issues raised with DCD and define DCD protocols and their ability to comply with established regulatory guidelines while respecting the wishes of patients and their surrogates through informed decisions making about organ donation and end-of-life care.