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• W2027937507 abstract "In this issue of Annals, 2 groups present views about appropriate paths forward in the controversial arena of uncontrolled donation after circulatory determination of death. These groups share a common, laudable goal: to improve thinking and practice around uncontrolled donation after circulatory determination of death to help it meet the growing needs of patients with end-stage organ dysfunction. The groups take different approaches to this shared goal: Dr. Bernat’s group attempts to provide a logically coherent definition of how death can be determined in the uncontrolled donation after circulatory determination of death setting to allow such protocols to proceed; the group led by Drs. Wall and Goldfrank focuses on ways to improve uncontrolled donation after circulatory determination of death protocols to promote the interests of prospective recipients and donors alike. Unfortunately, the groups also share tendencies to perpetuate arguments that have not previously engendered consensus. In addition, I have some concerns about the statistical analysis used to support their respective positions. Perhaps most importantly, both groups sidestep the elephant in the room: that the prevailing paradigm about the ethics of organ donation, which rests on the need for the donor to be unambiguously dead before organ recovery, is inherently flawed and ripe for replacement. Bernat’s group focuses on substituting a permanence standard for an irreversibility standard in determining death, failing to acknowledge that even if we achieved consensus on this distinction, it would not resurrect the dead-donor rule from its fatal flaws. Wall and Goldfrank’s group uses utilitarian reasoning to justify several uncontrolled donation after circulatory determination of death processes, but fails to provide an overall framework on which the ethics of organ donation might rest. This editorial will not detail the serious flaws with the dead-donor rule because these have been clarified in previous articles and can be summed up briefly with 3 points. First, dying is a process; therefore, death cannot be unambiguously diagnosed as present or absent at a given instant. This is more than a question of permanence versus irreversibility; it is a biologic reality that is made more obviously true with each passing year," @default.
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• W2027937507 date "2014-04-01" @default.
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• W2027937507 title "Donation After Circulatory Determination of Death: Time for Transparency" @default.
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• W2027937507 doi "https://doi.org/10.1016/j.annemergmed.2013.09.020" @default.
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