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Ethical Issues Related to Donation and Transplantation of Donation After Circulatory Determination of Death Donors

      Summary: With the continuing disparity between organ supply to match the increasing demand for kidney transplants in patients with renal failure, donation after the circulatory determination of death (DCDD) has become an important and increasing global source of kidneys for clinical use. The concern that the outcomes of controlled DCDD donor kidney transplants were inferior to those obtained from donors declared dead by neurologic criteria has largely diminished because large-scale registry and single-center reports consistently have reported favorable outcomes. For uncontrolled DCDD kidney transplants, outcomes are correspondingly acceptable, although there is a greater risk of primary nonfunction. The potential of DCDD remains unrealized in many countries because of the ethical concerns and resource implications in the utilization of these donor kidneys for transplantation. In this review, we discuss the origin and definitions of DCDD donors, and examine the long-term outcomes of transplants from DCDD donor kidneys. We discuss the controversies, challenges, and ethical and legal barriers in the acceptance of DCDD, including the complexities of implementing and sustaining controlled and uncontrolled DCDD donor programs. The lessons learned from global leaders will assist a wider international recognition, acceptance, and development of DCDD transplant programs that will noticeably facilitate and address the global shortages of kidneys for transplantation, and ensure the opportunity for people who had indicated their desires to become organ donors fulfill their final wishes.

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      REFERENCES

        • Axelrod DA
        • Schnitzler MA
        • Xiao H
        • et al.
        An economic assessment of contemporary kidney transplant practice.
        Am J Transplant. 2018; 18: 1168-1176https://doi.org/10.1111/ajt.14702
        • Domínguez-Gil B
        • Ascher NL
        • Fadhil RAS
        • et al.
        The reality of inadequate patient care and the need for a global action framework in organ donation and transplantation.
        Transplantation. 2022;
        • WHO; Transplantation Society (TTS); Organizatión Nacional de Transplantes (ONT)
        Third WHO Global Consultation on Organ Donation and Transplantation: striving to achieve self-sufficiency, March 23–25, 2010, Madrid, Spain.
        Transplantation. 2011; 91: S27-S28https://doi.org/10.1097/TP.0b013e3182190b29
        • Barnard CN.
        The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town.
        S Afr Med J. 1967; 41: 1271-1274
        • Kootstra G
        • Daemen JHC
        • Oomen APA.
        Categories of non-heart-beating donors.
        Transplant Proc. 1995; 27: 2893
        • Thuong M
        • Ruiz A
        • Evrard P
        • et al.
        New classification of donation after circulatory death donors definitions and terminology.
        Transpl Int. 2016; 29: 749-759https://doi.org/10.1111/tri.12776
      1. Global observatory on donation and transplantation. Accessed April 20, 2022. http://www.transplant-observatory.org

        • Sprung CL
        • Ricou B
        • Hartog CS
        • et al.
        Changes in end-of-life practices in European intensive care units from 1999 to 2016.
        JAMA. 2019; 322: 1692-1704https://doi.org/10.1001/jama.2019.14608
        • Gräsner JT
        • Lefering R
        • Koster RW
        • et al.
        EuReCa ONE-27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe.
        Resuscitation. 2016; 105: 188-195https://doi.org/10.1016/j.resuscitation.2016.06.004
        • Soar J
        • Böttiger BW
        • Carli P
        • et al.
        European Resuscitation Council Guidelines 2021: adult advanced life support.
        Resuscitation. 2021; 161: 115-151https://doi.org/10.1016/j.resuscitation.2021.02.010
        • Summers DM
        • Johnson RJ
        • Hudson A
        • et al.
        Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study.
        Lancet. 2013; 381: 727-734https://doi.org/10.1016/S0140-6736(12)61685-7
        • Akoh JA
        • Denton MD
        • Bradshaw SB
        • et al.
        Early results of a controlled non-heart-beating kidney donor programme.
        Nephrol Dial Transplant. 2009; 24: 1992-1996https://doi.org/10.1093/ndt/gfp070
        • Summers DM
        • Johnson RJ
        • Allen J
        • et al.
        Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study.
        Lancet. 2010; 376: 1303-1311https://doi.org/10.1016/S0140-6736(10)60827-6
        • Haase B
        • Bos M
        • Boffa C
        • et al.
        Ethical, legal, and societal issues and recommendations for controlled and uncontrolled DCD.
        Transpl Int. 2016; 29: 771-779https://doi.org/10.1111/tri.12720
        • Bos MA.
        Ethical and legal issues in non-heart-beating organ donation.
        Transplantation. 2005; 79: 1143-1147https://doi.org/10.1097/01.tp.0000160761.86036.6c
        • Youngner SJ
        • Arnold RM.
        Ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadaver donors.
        JAMA. 1993; 269: 2769-2774
        • Domínguez-Gil B
        • Ascher N
        • Capron AM
        • et al.
        Expanding controlled donation after the circulatory determination of death: statement from an international collaborative.
        Intensive Care Med. 2021; 47: 1059-1060https://doi.org/10.1007/s00134-021-06435-w
        • Bell MD.
        Non-heart beating organ donation: old procurement strategy–new ethical problems.
        J Med Ethics. 2003; 29: 176-181https://doi.org/10.1136/jme.29.3.176
        • Gardiner D
        • Riley B.
        Non-heart-beating organ donation - solution or a step too far?.
        Anaesthesia. 2007; 62: 431-433https://doi.org/10.1111/j.1365-2044.2007.05093.x
        • Manara AR
        • Murphy PG
        • O'Callaghan G
        Donation after circulatory death.
        Br J Anaesth. 2012; 108: i108-i121https://doi.org/10.1093/bja/aer357
        • Manara AR
        • Pittman JA
        • Braddon FE.
        Reasons for withdrawing treatment in patients receiving intensive care.
        Anaesthesia. 1998; 53: 523-528https://doi.org/10.1046/j.1365-2044.1998.t01-1-00407.x
        • Wunsch H
        • Harrison DA
        • Harvey S
        • Rowan K.
        End-of-life decisions: a cohort study of the withdrawal of all active treatment in intensive care units in the United Kingdom.
        Intensive Care Med. 2005; 31: 823-831https://doi.org/10.1007/s00134-005-2644-y
        • Kon AA
        • Shepard EK
        • Sederstrom NO
        • et al.
        Defining Futile and Potentially Inappropriate Interventions: a policy statement from the Society of Critical Care Medicine Ethics Committee.
        Crit Care Med. 2016; 44: 1769-1774https://doi.org/10.1097/CCM.0000000000001965
        • Manara A.
        Bespoke end-of-life decision making in ICU: has the tailor got the right measurements?.
        Crit Care Med. 2015; 43: 909-910https://doi.org/10.1097/CCM.0000000000000837
        • Manara AR
        • Thomas I
        • Harding R.
        A case for stopping the early withdrawal of life sustaining therapies in patients with devastating brain injuries.
        J Intensive Care Soc. 2016; 17: 295-301https://doi.org/10.1177/1751143716647980
        • Harvey D
        • Butler J
        • Groves J
        • et al.
        Management of perceived devastating brain injury after hospital admission: a consensus statement from stakeholder professional organizations.
        Br J Anaesth. 2018; 120: 138-145https://doi.org/10.1016/j.bja.2017.10.002
        • Rohaut B
        • Claassen J.
        Decision making in perceived devastating brain injury: a call to explore the impact of cognitive biases.
        Br J Anaesth. 2018; 120: 5-9https://doi.org/10.1016/j.bja.2017.11.007
        • Sandroni C
        • D'Arrigo S
        • Cacciola S
        • et al.
        Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review.
        Intensive Care Med. 2020; 46: 1803-1851https://doi.org/10.1007/s00134-020-06198-w
        • Perel P
        • Arango M
        • Clayton T
        • et al.
        • MRC CRASH Trial Collaborators
        Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients.
        BMJ. 2008; 336: 425-429https://doi.org/10.1136/bmj.39461.643438.25
        • Hemphill 3rd, JC,
        • Bonovich DC
        • Besmertis L
        • et al.
        The ICH score: a simple, reliable grading scale for intracerebral hemorrhage.
        Stroke. 2001; 32: 891-897https://doi.org/10.1161/01.str.32.4.891
        • Mourand I
        • Machi P
        • Nogué E
        • et al.
        Diffusion-weighted imaging score of the brain stem: a predictor of outcome in acute basilar artery occlusion treated with the Solitaire FR device.
        AJNR Am J Neuroradiol. 2014; 35: 1117-1123https://doi.org/10.3174/ajnr.A3870
        • Randhawa G.
        Death and organ donation: meeting the needs of multiethnic and multifaith populations.
        Br J Anaesth. 2012; 108: i88-i91https://doi.org/10.1093/bja/aer385
        • Souter M
        • Van Norman G.
        Ethical controversies at end of life after traumatic brain injury: defining death and organ donation.
        Crit Care Med. 2010; 38: S502-S509https://doi.org/10.1097/CCM.0b013e3181ec5354
        • Richards B
        • Rogers WA.
        Organ donation after cardiac death: legal and ethical justifications for antemortem interventions.
        Med J Aust. 2007; 187: 168-170https://doi.org/10.5694/j.1326-5377.2007.tb01178.x
        • Organ and Tissue Authority and the DonateLife Network
        Best practice guideline for donation after circulatory determination of death (DCDD) in Australia.
        Edition 1.0. October 2021
        • Lomero M
        • Gardiner D
        • Coll E
        • et al.
        Donation after circulatory death today: an updated overview of the European landscape.
        Transpl Int. 2020; 33: 76-88https://doi.org/10.1111/tri.13506
        • Shemie SD
        • Baker AJ
        • Knoll G
        • et al.
        National recommendations for donation after cardiocirculatory death in Canada: donation after cardiocirculatory death in Canada.
        CMAJ. 2006; 175: S1https://doi.org/10.1503/cmaj.060895
        • Critical Care Medicine, Ethics and Transplant Anesthesia Committee
        Statement on controlled organ donation after circulatory death.
        2017
        • Niemann CU
        • Feiner J
        • Swain S
        • et al.
        Therapeutic hypothermia in deceased organ donors and kidney-graft function.
        N Engl J Med. 2015; 373: 405-414https://doi.org/10.1056/NEJMoa1501969
        • Shemie SD
        • Hornby L
        • Baker A
        • et al.
        International guideline development for the determination of death.
        Intensive Care Med. 2014; 40: 788-797https://doi.org/10.1007/s00134-014-3242-7
        • Dailey M
        • Geary SP
        • Merrill S
        • Eijkholt M.
        Enabling donation after cardiac death in the emergency department: overcoming clinical, legal, and ethical concerns.
        J Emerg Med. 2017; 52: 588-592https://doi.org/10.1016/j.jemermed.2016.11.025
        • Joffe A.
        DCDD donors are not dead.
        Hastings Cent Rep. 2018; 48: S29-S32https://doi.org/10.1002/hast.949
        • Dalle Ave AL
        • Bernat JL.
        Donation after brain circulation determination of death.
        BMC Med Ethics. 2017; 18: 15https://doi.org/10.1186/s12910-017-0173-1
        • Ortega-Deballon I
        • Hornby L
        • Shemie SD.
        Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes.
        Crit Care. 2015; 19: 268https://doi.org/10.1186/s13054-015-0985-7
        • Dalle Ave AL
        • Bernat JL.
        Uncontrolled donation after circulatory determination of death: a systematic ethical analysis.
        J Intensive Care Med. 2018; 33: 624-634https://doi.org/10.1177/0885066616682200
        • Ortega-Deballon I
        • Rodríguez-Arias D.
        Uncontrolled DCD: when should we stop trying to save the patient and focus on saving the organs?.
        Hastings Cent Rep. 2018; 48: S33-S35https://doi.org/10.1002/hast.950
        • Bernat JL
        • Capron AM
        • Bleck TP
        • et al.
        The circulatory-respiratory determination of death in organ donation.
        Crit Care Med. 2010; 38: 963-970https://doi.org/10.1097/CCM.0b013e3181c58916
        • Dhanani S
        • Hornby L
        • van Beinum A
        • et al.
        Resumption of cardiac activity after withdrawal of life-sustaining measures.
        N Engl J Med. 2021; 384: 345-352https://doi.org/10.1056/NEJMoa2022713
        • Hornby K
        • Hornby L
        • Shemie SD.
        A systematic review of autoresuscitation after cardiac arrest.
        Crit Care Med. 2010; 38: 1246-1253https://doi.org/10.1097/CCM.0b013e3181d8caaa
        • Sheth KN
        • Nutter T
        • Stein DM
        • et al.
        Autoresuscitation after asystole in patients being considered for organ donation.
        Crit Care Med. 2012; 40: 158-161https://doi.org/10.1097/CCM.0b013e31822f0b2a
        • Suntharalingam C
        • Sharples L
        • Dudley C
        • et al.
        Time to cardiac death after withdrawal of life-sustaining treatment in potential organ donors.
        Am J Transplant. 2009; 9: 2157-2165https://doi.org/10.1111/j.1600-6143.2009.02758.x
        • Allen MB
        • Billig E
        • Reese PP
        • et al.
        Donor hemodynamics as a predictor of outcomes after kidney transplantation from donors after cardiac death.
        Am J Transplant. 2016; 16: 181-193https://doi.org/10.1111/ajt.13432
        • Peters-Sengers H
        • Houtzager JHE
        • Heemskerk MBA
        • et al.
        DCD donor hemodynamics as predictor of outcome after kidney transplantation.
        Am J Transplant. 2018; 18: 1966-1976https://doi.org/10.1111/ajt.14676
        • Lim WH
        • McDonald SP
        • Russ GR
        • et al.
        Association between delayed graft function and graft loss in donation after cardiac death kidney transplants-a paired kidney registry analysis.
        Transplantation. 2017; 101: 1139-1143https://doi.org/10.1097/TP.0000000000001323
        • Rady MY
        • Verheijde JL.
        Prediction of time to death after terminal withdrawal of life-support in non-heartbeating organ donation: unaccounted variables and window of opportunity.
        Crit Care Med. 2012; 40: 986-988https://doi.org/10.1097/CCM.0b013e318236e2f3
        • Rabinstein AA
        • Yee AH
        • Mandrekar J
        • et al.
        Prediction of potential for organ donation after cardiac death in patients in neurocritical state: a prospective observational study.
        Lancet Neurol. 2012; 11: 414-419https://doi.org/10.1016/S1474-4422(12)70060-1
        • Pine JK
        • Goldsmith PJ
        • Ridgway DM
        • et al.
        Predicting donor asystole following withdrawal of treatment in donation after cardiac death.
        Transplant Proc. 2010; 42: 3949-3950https://doi.org/10.1016/j.transproceed.2010.09.080
        • Kotsopoulos A
        • Vos P
        • Witjes M
        • et al.
        Prospective multicenter observational cohort study on time to death in potential controlled donation after circulatory death donors-development and external validation of prediction models: the DCD III study.
        Transplantation. Published online March 8, 2022. 2022; https://doi.org/10.1097/TP.0000000000004106
        • Lin Y
        • Teixeira-Pinto A
        • Opdam H
        • et al.
        Non-utilization of kidneys from donors after circulatory determinant of death.
        Transplant Direct. 2022; 8: e1331
        • Watson CJE
        • Hunt F
        • Messer S
        • et al.
        In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival.
        Am J Transplant. 2019; 19: 1745-1758https://doi.org/10.1111/ajt.15241
        • Hessheimer AJ
        • de la Rosa G
        • Gastaca M
        • et al.
        Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss.
        Am J Transplant. 2022; 22: 1169-1181https://doi.org/10.1111/ajt.16899
        • Hessheimer AJ
        • Coll E
        • Torres F
        • et al.
        Normothermic regional perfusion vs. super-rapid recovery in controlled donation after circulatory death liver transplantation.
        J Hepatol. 2019; 70: 658-665https://doi.org/10.1016/j.jhep.2018.12.013
        • van de Leemkolk FEM
        • Schurink IJ
        • Dekkers OM
        • et al.
        Abdominal normothermic regional perfusion in donation after circulatory death: a systematic review and critical appraisal.
        Transplantation. 2020; 104: 1776-1791https://doi.org/10.1097/TP.0000000000003345
        • Gaurav R
        • Butler AJ
        • Kosmoliaptsis V
        • et al.
        Liver transplantation outcomes from controlled circulatory death donors: static cold storage vs in situ normothermic regional perfusion vs ex situ normothermic machine perfusion.
        Ann Surg. 2022; 275 (Published online March 3): 1156-1164https://doi.org/10.1097/SLA.0000000000005428
        • De Beule J
        • Vandendriessche K
        • Pengel LHM
        • et al.
        A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation.
        Transpl Int. 2021; 34: 2046-2060https://doi.org/10.1111/tri.14121
        • Padilla M
        • Coll E
        • Fernández-Pérez C
        • et al.
        Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic regional perfusion.
        Am J Transplant. 2021; 21: 3618-3628https://doi.org/10.1111/ajt.16622
      2. Dalle Ave AL, Bernat JL.Donation after brain circulation determination of death. BMC Med Ethics. 2017;18(1):15. doi: https://doi.org/10.1186/s12910-017-0173-1.

        • Miñambres E
        • Suberviola B
        • Dominguez-Gil B
        • et al.
        Improving the outcomes of organs obtained from controlled donation after circulatory death donors using abdominal normothermic regional perfusion.
        Am J Transplant. 2017; 17: 2165-2172https://doi.org/10.1111/ajt.14214
        • Jochmans I
        • Hessheimer AJ
        • Neyrinck AP
        • et al.
        Consensus statement on normothermic regional perfusion in donation after circulatory death: report from the European Society for Organ Transplantation's Transplant Learning Journey.
        Transpl Int. 2021; 34: 2019-2030https://doi.org/10.1111/tri.13951
        • Smith M
        • Dominguez-Gil B
        • Greer DM
        • et al.
        Organ donation after circulatory death: current status and future potential.
        Intensive Care Med. 2019; 45: 310-321https://doi.org/10.1007/s00134-019-05533-0
        • Domínguez-Gil B
        • Duranteau J
        • Mateos A
        • et al.
        Uncontrolled donation after circulatory death: European practices and recommendations for the development and optimization of an effective programme.
        Transpl Int. 2016; 29: 842-859https://doi.org/10.1111/tri.12734
        • Miñambres E
        • Rubio JJ
        • Coll E
        • Domínguez-Gil B.
        Donation after circulatory death and its expansion in Spain.
        Curr Opin Organ Transplant. 2018; 23: 120-129https://doi.org/10.1097/MOT.0000000000000480
        • Mizutani K
        • Ono Y
        • Kinukawa T
        • et al.
        Use of marginal organs from non-heart-beating cadaveric kidney donors.
        Transplantation. 2001; 72: 1376-1380https://doi.org/10.1097/00007890-200110270-00007
        • Hattori R
        • Ono Y
        • Yoshimura N
        • et al.
        Long-term outcome of kidney transplant using non-heart-beating donor: multicenter analysis of factors affecting graft survival.
        Clin Transplant. 2003; 17: 518-521https://doi.org/10.1046/j.1399-0012.2003.00080.x
        • Sánchez-Fructuoso AI
        • Marques M
        • Prats D
        • et al.
        Victims of cardiac arrest occurring outside the hospital: a source of transplantable kidneys.
        Ann Intern Med. 2006; 145: 157-164https://doi.org/10.7326/0003-4819-145-3-200608010-00003
        • Hoogland ER
        • Snoeijs MG
        • Winkens B
        • et al.
        Kidney transplantation from donors after cardiac death: uncontrolled versus controlled donation.
        Am J Transplant. 2011; 11: 1427-1434https://doi.org/10.1111/j.1600-6143.2011.03562.x
        • Demiselle J
        • Augusto JF
        • Videcoq M
        • et al.
        Transplantation of kidneys from uncontrolled donation after circulatory determination of death: comparison with brain death donors with or without extended criteria and impact of normothermic regional perfusion.
        Transpl Int. 2016; 29: 432-442https://doi.org/10.1111/tri.12722
        • Peters-Sengers H
        • Homan van der Heide JJ
        • Heemskerk MBA
        • et al.
        Similar 5-year estimated glomerular filtration rate between kidney transplants from uncontrolled and controlled donors after circulatory death-a Dutch cohort Study.
        Transplantation. 2017; 101: 1144-1151https://doi.org/10.1097/TP.0000000000001211
        • Del Río F
        • Andrés A
        • Padilla M
        • et al.
        Kidney transplantation from donors after uncontrolled circulatory death: the Spanish experience.
        Kidney Int. 2019; 95: 420-428https://doi.org/10.1016/j.kint.2018.09.014
        • Sánchez-Fructuoso AI
        • Pérez-Flores I
        • Del Río F
        • et al.
        Uncontrolled donation after circulatory death: a cohort study of data from a long-standing deceased-donor kidney transplantation program.
        Am J Transplant. 2019; 19: 1693-1707https://doi.org/10.1111/ajt.15243
        • Molina M
        • Guerrero-Ramos F
        • Fernández-Ruiz M
        • et al.
        Kidney transplant from uncontrolled donation after circulatory death donors maintained by nECMO has long-term outcomes comparable to standard criteria donation after brain death.
        Am J Transplant. 2019; 19: 434-447https://doi.org/10.1111/ajt.14991
        • Antoine C
        • Savoye E
        • Gaudez F
        • et al.
        Kidney transplant from uncontrolled donation after circulatory death: contribution of normothermic regional perfusion.
        Transplantation. 2020; 104: 130-136https://doi.org/10.1097/TP.0000000000002753
        • Summers DM
        • Pettigrew GJ.
        Kidney transplantation following uncontrolled donation after circulatory death.
        Curr Opin Organ Transplant. 2020; 25: 144-150https://doi.org/10.1097/MOT.0000000000000742
        • Gardiner D
        • McGee A.
        Death, permanence and current practice in donation after circulatory death.
        QJM. 2017; 110: 199-201https://doi.org/10.1093/qjmed/hcw184
        • Dalle Ave AL
        • Shaw DM
        • Gardiner D.
        Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-an ethical analysis of an unresolved clinical dilemma.
        Resuscitation. 2016; 108: 87-94https://doi.org/10.1016/j.resuscitation.2016.07.003
        • Soar J
        • Böttiger BW
        • Carli P
        • et al.
        European Resuscitation Council Guidelines 2021: adult advanced life support.
        Resuscitation. 2021; 161: 115-151https://doi.org/10.1016/j.resuscitation.2021.02.010
        • Panchal AR
        • Bartos JA
        • Cabañas JG
        • et al.
        Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2020; 142: S366-S468https://doi.org/10.1161/CIR.0000000000000916
        • Wall SP
        • Kaufman BJ
        • Gilbert AJ
        • AL ET
        Derivation of the uncontrolled donation after circulatory determination of death protocol for New York city.
        Am J Transplant. 2011; 11: 1417-1426https://doi.org/10.1111/j.1600-6143.2011.03582.x
        • Molina M
        • Domínguez-Gil B
        • Pérez-Villares JM
        • Andrés A.
        Uncontrolled donation after circulatory death: ethics of implementation.
        Curr Opin Organ Transplant. 2019; 24: 358-363https://doi.org/10.1097/MOT.0000000000000648
        • Committee on Bioethics (DH-BIO) of the Council of Europe
        Guide on the decision-making process regarding medical treatment in end-of-life situations.
        2019 (Accessed April 20, 2022.)
        • Hernández-Tejedor A
        • Peñuelas O
        • Sirgo Rodríguez G
        • et al.
        Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients.
        Med Intensiva. 2017; 41: 285-305https://doi.org/10.1016/j.medin.2017.03.004
        • Martínez Soba F
        • Masnou Burrallo N
        • de la Rosa Rodríguez G
        • Povar Marco J
        Emergency department staff and the organ donation process: recommendations from the joint working group of the National Transplant Organization and the Spanish Society of Emergency Medicine (ONT-SEMES).
        Emergencias. 2016; 28: 193-200
        • Truog RD
        • Campbell ML
        • Curtis JR
        • et al.
        Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine.
        Crit Care Med. 2008; 36: 953-963https://doi.org/10.1097/CCM.0B013E3181659096
        • Hutin A
        • Abu-Habsa M
        • Burns B
        • et al.
        Early ECPR for out-of-hospital cardiac arrest: best practice in 2018.
        Resuscitation. 2018; 130: 44-48https://doi.org/10.1016/j.resuscitation.2018.05.004
        • Holmberg MJ
        • Geri G
        • Wiberg S
        • et al.
        Extracorporeal cardiopulmonary resuscitation for cardiac arrest: a systematic review.
        Resuscitation. 2018; 131: 91-100https://doi.org/10.1016/j.resuscitation.2018.07.029
        • Manara AR
        • Dominguez-Gil B
        • Pérez-Villares JM
        • Soar J.
        What follows refractory cardiac arrest: death, extra-corporeal cardiopulmonary resuscitation (E-CPR), or uncontrolled donation after circulatory death?.
        Resuscitation. 2016; 108: A3-A5https://doi.org/10.1016/j.resuscitation.2016.08.028
        • Prabhu A
        • Parker LS
        • DeVita MA.
        Caring for patients or organs: new therapies raise new dilemmas in the emergency department.
        Am J Bioeth. 2017; 17: 6-16https://doi.org/10.1080/15265161.2017.1299239
        • Jr Roncon-Albuquerque R
        • S Gaião
        • Figueiredo P
        • et al.
        An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest.
        Resuscitation. 2018; 133: 88-94https://doi.org/10.1016/j.resuscitation.2018.10.016
        • Shemie SD
        • Robertson A
        • al Beitel J, et
        End-of-life conversations with families of potential donors: leading practices in offering the opportunity for organ donation.
        Transplantation. 2017; 101: S17-S26https://doi.org/10.1097/TP.0000000000001696
        • Perez Villares JM
        • Lara Rosales R
        • Gil Pinero E
        • et al.
        Ethics in approaching families about organ donation from patients in out-of-hospital asystole.
        Emergencias. 2016; 28: 55-61
        • Hornby L
        • Dhanani S
        • Shemie SD.
        Update of a systematic review of autoresuscitation after cardiac arrest.
        Crit Care Med. 2018; 46: e268-e272https://doi.org/10.1097/CCM.0000000000002920
        • Andrés A
        • Morales E
        • Vázquez S
        • et al.
        Lower rate of family refusal for organ donation in non-heart-beating versus brain-dead donors.
        Transplant Proc. 2009; 41: 2304-2305https://doi.org/10.1016/j.transproceed.2009.06.039
        • Bernat JL
        • D'Alessandro AM
        • Port FK
        • et al.
        Report of a national conference on donation after cardiac death.
        Am J Transplant. 2006; 6: 281-291https://doi.org/10.1111/j.1600-6143.2005.01194.x
        • Pérez Castro P
        • Salas SP
        Ethical issues of organ donation after circulatory death: considerations for a successful implementation in Chile.
        Dev World Bioeth. Published online November 13, 2021. 2021; https://doi.org/10.1111/dewb.12338
        • Summers DM
        • Watson CJ
        • Pettigrew GJ
        • et al.
        Kidney donation after circulatory death (DCD): state of the art.
        Kidney Int. 2015; 88: 241-249https://doi.org/10.1038/ki.2015.88