Life After Death: Ethical Considerations of CPR in Brain-Dead Pediatric Organ Donors

The ethical considerations surrounding organ-preserving cardiopulmonary resuscitation (OP-CPR) in pediatric patients with brain death highlight tensions between preserving organ viability and respecting bodily integrity. This article explores these complexities through the case of JJ, a 12-year-old patient declared dead by neurological criteria, whose parents authorized organ donation. When JJ experienced cardiovascular collapse before organ procurement, the organ procurement organization's off-site director instructed hospital staff to perform OP-CPR, prompting ethical concerns from the pediatric intensive care unit (PICU) team. This Ethics Rounds article presents 3 perspectives on OP-CPR: (1) An ethicist working for an organ procurement organization asserts that OP-CPR aligns with the family's intent and the principle of justice by increasing organ availability; (2) 2 pediatric intensive care attendings and bioethicists argue OP-CPR may not be ethically justified due to the low likelihood of achieving the primary goal, potential harm to the donor's dignity and personhood, and concerns about poor communication and lack of explicit permission; and (3) 3 nurses reveal challenges related to communication, moral distress, and institutional policies that pertain to the practice of OP-CPR. The article underscores the need for clear guidelines, improved collaboration between PICU teams and organ procurement organizations, and ethical frameworks that address both conscientious objection and conscientious commitment in the context of OP-CPR.