Innovations in DCD: Ethical and Legal Considerations for the OPTN, OPOs, Transplant Surgeons, and Recovery Teams

Donation after circulatory death (DCD) is increasing in the United States, potentially leading to more organs for transplant candidates. In this article, we address how increasing focus on DCD recovery and using novel procurement techniques, combined with new pressures on Organ Procurement Organizations (OPOs) to complete more organ recoveries, creates new ethical dilemmas that must be proactively resolved to preserve community trust in the organ transplant process.

While novel techniques like normothermic regional perfusion and centralizing organ recovery in donor management centers can mitigate some of the technical issues associated with DCD, and recovering organs from unrepresented patients can increase the organ pool, these techniques pose new challenges for defining death and ensuring that organ donation does not unduly influence clinical care.

Pursuing innovative DCD strategies requires adequate collaboration between OPO representatives, ICU clinicians, donor family members, and the public to increase the organ pool while maintaining trust in transplant.