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• W4243412921 abstract "Truog and Miller1Truog RD Miller FG Counterpoint: are donors after circulatory death really dead, and does it matter? No and not really.Chest. 2010; 138: 16-18Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar criticize elements of the recent analysis of the circulatory determination of death that my colleagues and I conducted.2Bernat JL Capron AM Bleck TP et al.The circulatory-respiratory determination of death in organ donation.Crit Care Med. 2010; 38: 972-979Crossref Scopus (191) Google Scholar Their most penetrating criticism is that in DCDD (donation after the determination of cardiac death) donors we blurred the ontologic distinction between death and dying. They correctly note that I have previously analyzed this distinction in depth in the DCDD context3Bernat JL Are organ donors after cardiac death really dead?.J Clin Ethics. 2006; 17: 122-132PubMed Google Scholar and then pose an illustrative case comparison. My rebuttal addresses this distinction and shows that the essential issue in DCDD is not one of ontology but of medical practice. Truog and Miller1Truog RD Miller FG Counterpoint: are donors after circulatory death really dead, and does it matter? No and not really.Chest. 2010; 138: 16-18Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar ask how we could consider the patient in case 1 to be dead if the analogous patient in case 2, who represents the typical patient we all hope will undergo a successful resuscitation, is not dead. They acknowledge that most hospital death determinations are made at the moment of asystole, which, from a purely ontologic perspective, is before the patient is dead. They observe that this practice is acceptable because “nothing consequential will happen to the patient over the next several minutes” until the patient is truly dead. Our society permits physicians to declare death earlier for social benefits, rather than awaiting signs of rigor mortis or other unequivocal signs of circulatory irreversibility. We argue that cessation of circulation and respiration is permanent at that point in time after asystole when autoresuscitation cannot occur and if CPR will not be performed. Because the transition to irreversible cessation of circulation and respiration is rapid and inevitable, permanence serves as a valid surrogate marker for irreversibility. We argue that this same situation holds for both organ donation and nondonation circulatory death determinations because identical conditions apply. However, if an ICU physician declared the patient in case 3 dead after 2 min of asystole based on the plan not to perform CPR, but then performed successful CPR, it would show that the prevailing practice of early death determination could create errors if the conditions under which it is valid have been violated. Similarly, if an ICU physician were to perform CPR on a DCDD donor (analogous to case 3), the same error would occur. From a purely ontologic perspective, neither patient is dead until irreversibility can be proved or is obvious. But we allow physicians to declare death at the point of permanent cessation without awaiting or proving irreversibility because this is what physicians and society have determined that we mean by death. Death statutes, such as the Uniform Determination of Death Act, accommodate this practice by their language, stating, “A determination of death must be made in accordance with accepted medical standards.” Thus, medical practice issues, not ontologic ones, are paramount in the DCDD argument. Truog and Miller's claim that the DCDD case is more consequential because of the lethality of removing organs is simply wrong. In fact, organ donation has no impact whatsoever on the inevitable process during which permanent cessation of circulation becomes irreversible.4Menikoff J Doubts about death: the silence of the Institute of Medicine.J Law Med Ethics. 1998; 26: 157-165Crossref PubMed Scopus (62) Google Scholar This process parallels the gradual destruction of the brain by circulatory arrest and proceeds completely unaffected by organ removal, including that of the asystolic heart." @default.
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• W4243412921 date "2010-07-01" @default.
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• W4243412921 title "Rebuttal" @default.
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• W4243412921 doi "https://doi.org/10.1378/chest.10-0650" @default.
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