Ethical issues of importance to anesthesiologists regarding organ donation after cardiac death

Purpose of review An increasing disparity between the demand and the supply for vital organs for transplantation has led to continuing efforts to increase the organ donor pool. Programs have developed that allow patients who wish to terminate life-sustaining medical therapies, such as mechanical ventilation, to donate vital organs after cardiopulmonary arrest occurs. The purpose of this review is to discuss ethical and legal issues important to anesthesiologists involved in these donations after cardiac death. Recent developments Withdrawal of life-sustaining measures sometimes occurs in an operating room to minimize the time between cardiac arrest and organ donation, raising important questions: (1) What is the anesthesiologist's role during this process? (2) Who provides end-of-life care to the organ donor? (3) How long should cardiac arrest persist before organ donation is permitted? (4) Are medical therapies directed at organ preservation acceptable during the dying process? In addition, broader social justice issues are of increasing concern, such as racial and economic disparities between vital organ donors and recipients. Summary Most anesthesiologists do not have appropriate training to provide end-of-life care for donation after cardiac death. An ethically and medically appropriate waiting period between the onset of asystole and organ donation is currently unknown, but the waiting period should err on the side of the donor's best interests, not organ viability. Medical interventions for the sole purpose of organ preservation that do not benefit the donor may not be ethical. Finally, the reasons for social disparities between organ donors and organ recipients should be investigated and corrected.