Bioética, reanimación cardiopulmonar y donación de órganos en asistolia

  1. Lora Deltoro, Pablo de
  2. Ortega Deballón, Iván María
  3. Rodríguez-Arias Vailhen, David
  4. Seoane, José-Antonio
  5. Serrano, Alfredo
  6. Triviño Caballero, Rosana
Journal:
Dilemata

ISSN: 1989-7022

Year of publication: 2013

Issue Title: Responsabilidades y Justicia Global

Issue: 13

Pages: 283-296

Type: Article

More publications in: Dilemata

Abstract

The so-called uncontrolled donation after circulatory determination of death (uDCDD) have been implemented in several countries, including Spain and France, to increase the availability of organs for transplantation. These protocols allow obtaining kidneys, livers and lungs of patients who do not survive cardio-pulmonary resuscitation performed in out-of-hospital settings. Simultaneously with the development and recent proliferation of these protocols, some emergency teams have begun to employ unconventional methods of CPR, with still uncertain but promising results. The coexistence of these two possibilities raises some questions: At what point should attempts to save a patient with circulatory arrest be abandoned so that this individual can begin to be considered as a potential organ donor? How to manage potential conflicts of loyalties that may arise within emergency and procurement teams? How should the information to the families of those patients and potential organ donors be managed? This article gathers the conclusions of a workshop in which an interdisciplinary working group addressed these and other questions related to DCDD and non-conventional CPR.

Bibliographic References

  • Agostinucci, J. M., M. Ruscev, et al. (2011). “Out-of-hospital use of an automated chest compression device: facilitating access to extracorporeal life support or non-heart-beating organ procurement.” Am J Emerg Med 29(9): 1169-1172.
  • Belohlavek, J., K. Kucera, et al. (2012). “Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study”.” J Transl Med 10: 163.
  • Bernat, J. L. (2010). “How the distinction between “irreversible” and “permanent” illuminates circulatory-respiratory death determination.” J Med Philos 35(3): 242-255.
  • Bernat, J. L. (2013). “Determining Death in Uncontrolled DCDD Organ Donors.” Hastings Cent Rep 43(1): 30-33.
  • Bernat, J. L., T. P. Bleck, et al. (2013). “Circulatory Death Determination in Uncontrolled Organ Donors: A Panel Viewpoint.” Ann Emerg Med.
  • Bernat, J. L., A. M. Capron, et al. (2010). “The circulatory-respiratory determination of death in organ donation.” Crit Care Med 38(3): 963-970.
  • Blanco, A. (2012). “El trasplante y la escasez.” Bioética Complutense 11(Junio 2012): 13-15.
  • Boucek, M. M., C. Mashburn, et al. (2008). “Pediatric heart transplantation after declaration of cardiocirculatory death.” N Engl J Med 359(7): 709-714.
  • Bracco, D., N. Noiseux, et al. (2007). “The thin line between life and death.” Intensive Care Med 33(5): 751-754.
  • Breitkreutz, R., F. Walcher, et al. (2007). “Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm.” Crit Care Med 35(5 Suppl): S150-161.
  • Cardarelli, M. G., A. J. Young, et al. (2009). “Use of extracorporeal membrane oxygenation for adults in cardiac arrest (E-CPR): a meta-analysis of observational studies.” ASAIO J 55(6): 581-586.
  • Carli, P. (2010) “[Prehospital cardiac arrest and ECMO: state of art].” E-memories de l’Académie Nationale de Chirurgie 9, 10-13.
  • Corsiglia, D. (2007). “Reanimación cardiopulmonar: actualidad y expectativas futuras.” Revista de la Federación Argentina de Cardiología 36(2): 65-69.
  • Dhanani, S., L. Hornby, et al. (2012). “Variability in the determination of death after cardiac arrest: a review of guidelines and statements.” J Intensive Care Med 27(4): 238-252.
  • Doig, C. J. and D. A. Zygun (2008). “(Uncontrolled) donation after cardiac determination of death: a note of caution.” J Law Med Ethics 36(4): 760-765, 610.
  • Domínguez-Gil, B., B. Haase-Kromwijk, et al. (2011). “Current situation of donation after circulatory death in European countries.” Transplant international : official journal of the European Society for Organ Transplantation 24(7): 676-686.
  • Joffe, A. R., J. Carcillo, et al. (2011). “Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent.” Philosophy, Ethics, and Humanities in Medicine 6(17).
  • Jouffroy, R., L. Lamhaut, et al. (2013). “A new approach for early onset cardiogenic shock in acute colchicine overdose: place of early extracorporeal life support (ECLS)?” Intensive Care Med 39(6): 1163.
  • Lamhaut, L., R. Jouffroy, et al. (2012). “Successful treatment of refractory cardiac arrest by emergency physicians using pre-hospital ECLS.” Resuscitation 83(8): e177-178.
  • Lederer, W., C. Lichtenberger, et al. (2004). “Long-term survival and neurological outcome of patients who received recombinant tissue plasminogen activator during out-of-hospital cardiac arrest.” Resuscitation 61(2): 123-129.
  • Lee, S. W. and Y. S. Hong (2008). “Extracorporeal life-support in patients requiring CPR.” Lancet 372(9638): 512-514.
  • Lyon, R. M. (2012). “Extra-corporeal cardiopulmonary resuscitation--miracle cure or expensive futility?” Resuscitation 83(11): 1311-1312.
  • Marijon, E., W. Bougouin, et al. (2012). “[Sudden death of the adult: do not forget the hidden part of the iceberg!].” Rev Med Interne 33(10): 543-545.
  • Marquis, D. (2010). “Are DCD donors dead?” Hastings Center Report(may-june): 24-30.
  • Mateos-Rodriguez, A., L. Pardillos-Ferrer, et al. (2010). “Kidney transplant function using organs from non-heart-beating donors maintained by mechanical chest compressions.” Resuscitation 81(7): 904-907.
  • Miller, F. G. and R. D. Truog (2011). Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life, Oxford University Press.
  • Morimura, N., T. Sakamoto, et al. (2011). “Extracorporeal cardiopulmonary resuscitation for out-ofhospital cardiac arrest: A review of the Japanese literature.” Resuscitation 82(1): 10-14.
  • Munjal, K. G., S. P. Wall, et al. (2013). “A rationale in support of uncontrolled donation after circulatory determination of death.” Hastings Cent Rep 43(1): 19-26.
  • Nagao, K., K. Kikushima, et al. (2010). “Early induction of hypothermia during cardiac arrest improves neurological outcomes in patients with out-of-hospital cardiac arrest who undergo emergency cardiopulmonary bypass and percutaneous coronary intervention.” Circ J 74(1): 77-85.
  • Nolan, J. P., J. Soar, et al. (2010). “European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary.” Resuscitation 81(10): 1219-1276.
  • Organización Nacional de Trasplantes (2012). [Donación en asistolia en España: situación actual y recomendaciones. Documento de Consenso Nacional 2012].
  • Peek, G. J. (2011). “Community extracorporeal life support for cardiac arrest when should it be used?” Resuscitation 82(9): 1117.
  • Perkins, G. D., S. Brace, et al. (2010). “Mechanical chest-compression devices: current and future roles.” Curr Opin Crit Care 16(3): 203-210.
  • Robertson, J. A. (1999). “The dead donor rule.” Hastings Cent Rep 29(6): 6-14.
  • Rodriguez-Arias, D. and I. O. Deballon (2012). “Protocols for uncontrolled donation after circulatory death.” Lancet 379(9823): 1275-1276.
  • Scolletta, S., F. S. Taccone, et al. (2012). “Intra-arrest hypothermia during cardiac arrest: a systematic review.” Crit Care 16(2): R41.
  • Serrano, A., F. Nogal, et al. (2013). “[Revascularización coronaria durante la resucitación cardiopulmonar. Código Puente].” Medicina Intensiva 37(1): 33-43.
  • Sunde, K. (2008). “Experimental and clinical use of ongoing mechanical cardiopulmonary resuscitation during angiography and percutaneous coronary intervention.” Crit Care Med 36(11 Suppl): S405- 408.
  • Tenaillon, A. (2009). “[Uncontrolled donor after cardiac death, ethical aspects] “ Le Courrier de la Transplantation(9): 50-58.
  • Thuong, M. (2011). “Recommandations sur l’information et l’abord des proches des donneurs potentiels d’organes et de tissus décédés après arrêt cardiaque (DDAC), dans l’optique d’un prélèvement “ Ann. Fr. Med.Urgence 1: 438-441.
  • Vanden Hoek, T. L., L. J. Morrison, et al. (2010). “Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” Circulation 122(18 Suppl 3): S829-861.
  • Wall, S. P., B. J. Kaufman, et al. (2011). “Derivation of the Uncontrolled Donation after Circulatory Determination of Death Protocol for New York City.” Am J Transplant 11(7): 1417-1426.
  • Yang, C. L., J. Wen, et al. (2012). “Cardiocerebral resuscitation vs cardiopulmonary resuscitation for cardiac arrest: a systematic review.” Am J Emerg Med 30(5): 784-793.
  • Youngner, S. J., R. M. Arnold, et al. (1999). “When is “dead”?” Hastings Cent Rep 29(6): 14-21.