Richard L. Wolman, M.D., M.A.

Professor, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health
Committee Member, Committee on Ethics, American Society of Anesthesiologists
Chair, Ethics Committee, Society of Cardiovascular Anesthesiologists
Committee Member, Ethics Committee, University of Wisconsin Hospital and Clinics

The relative shortage of viable organs led to reemergence of organ procurement from nonheartbeating organ donors (donation after cardiac death or DCD) in 1992.  Despite relaxation of the strict criteria for DCD, administrative, legislative, and social proposals or changes to the organ donation process, DCD represented less than eleven percent of all deceased donors in 2008.  Unfortunately, many of these attempts to increase the number DCD donors resulted in ethical and moral controversies and only increased the public's existing misperceptions and fears regarding organ donation and DCD. 

Ethical dilemmas raised by DCD may be divided into those of a conceptual and practical nature.  These dilemmas are confounded by the fact that DCD combines two morally complex events, decisions and care of the donor at the end of life (withdrawal of life-sustaining medical therapies) and the generous gift of organ donation.  Thus, there may be problems and conflicts of interest in prioritization of care of the potential donor vs. that of the potential organ recipient, use of the presumptive approach to consent, possible violations of the donor's autonomous wishes, supremacy of donation over the donor's advance directives and end-of-life care wishes, decisions regarding who withdraws life-support, the premortem use of organ protection agents, definitions of death and the irreversibility of circulatory arrest in the age of resuscitation, and violations of the dead donor rule.  These dilemmas may be reduced but not entirely eliminated by careful adherence to protocols that respect the rights, autonomous wishes, and care of the prospective donor and that avoid conflicts of interest.

Learning Objectives:

At the conclusion of this webinar, the participant will have a clearer understanding of:

1.  The concept of donation after cardiac death:  criteria for DCD, the definitions
of death and irreversibility of cardiac function, and the ethical, medical procedural, and legal concerns involved in donation after cardiac death.

2.  The problems with linking withdrawal of life-sustaining medical therapies and organ donation:  the rights of organ donors and their families, possible conflicts of interest, prioritization of care, respect for the potential organ donor, who should withdraw care, the premortem use of organ preservation agents, and possible violations of the dead donor rule.

3.  The responsibilities of non-critical care anesthesiologists as well as critical care anesthesiologists in the process and practice of DCD and the ASA's "Sample Policy for Organ Donation after Cardiac Death."

4.  The importance of an ethical policy for the process of DCD. 

Accreditation Statement
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Society of Anesthesiologists designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. ASA will report credit to the American Board of Anesthesiologists with the ABA ID Number on record with ASA.

*An archive recording of this program will be available for sale 48 hours after the live event.