End-of-life organ donation for transplantation: stretching the ethical and legal boundaries of medical practice in society.

摘要

Implementation of organ donation after cardiac death (DCD) in the United States without antecedent public transparency has made healthcare professionals reluctant to accept DCD because of ethical and legal concerns (e.g., arbitrary criteria for declaring death, conflicting roles and interests in determining futility, and disruptive end-of-life [EOL]experiences for families), as presented by Dr. D'Alessandro and colleagues (1) in the current issue of Critical Care Medicine. Ironically, U.S. health policy groups, professional associations, and government health agencies endorse DCD as ethical and legal (2). The Health Resources and Services Administration touts DCD as a successful product of the Organ Donation and Transplantation Breakthrough Collaborative (2). The incongruent perspectives of healthcare professionals and policy makers raise questions. First, should there have been open debate about DCD before its final endorsement? Second, should professional and private organizations have undertaken legislative functions to reinterpret statutes (3) and redraft laws (4) to enforce DCD despite societal repercussions? Third, should government health agencies support "cultural shift" campaigns promoting DCD?