The ethics of donation after circulatory death organ recovery: an overview of new considerations arising from procurement practice and policy changes

PURPOSE OF REVIEW: The aim of this study is to examine ethical issues raised by organ recovery from donors after circulatory death (DCD). RECENT FINDINGS: Recent technological developments and policy modifications have implications for evolving ethical issues related to DCD organ procurement and donation. We identify four such changes and discuss the most significant ethical issues raised by each: the use of cardiac perfusion machines and the need to develop criteria to allow prioritization for organ preservation in joint thoracic-abdominal procurements, normothermic regional perfusion and the irreversibility criterion in the definition of death, practice variability in DCD withdrawal of care and death declarations, and equitable access to donation, and changes in organ procurement organization evaluation metrics and transplant system resource utilization. SUMMARY: The evolution of DCD donation raises new ethical concerns that require further analysis to ensure that deceased donors, donor families and transplant recipients are treated respectfully and equitably.