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Circulatory Death Determination in Uncontrolled Organ Donors ACOT Meeting February 28, 2012

Circulatory Death Determination in Uncontrolled Organ Donors ACOT Meeting February 28, 2012. James L. Bernat, M.D. Louis and Ruth Frank Professor of Neuroscience Professor of Neurology and Medicine Dartmouth Medical School. Overview. Foundational principles

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Circulatory Death Determination in Uncontrolled Organ Donors ACOT Meeting February 28, 2012

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  1. Circulatory Death Determination in Uncontrolled Organ DonorsACOT MeetingFebruary 28, 2012 James L. Bernat, M.D. Louis and Ruth Frank Professor of Neuroscience Professor of Neurology and Medicine Dartmouth Medical School

  2. Overview • Foundational principles • Concepts of uncontrolled donation after the circulatory determination of death (uDCDD) • Application of the foundational principles to uDCDD • The relationship between cessation of systemic circulation and cessation of brain functions

  3. Foundational Principles • Why cessation of systemic circulation causes death • Permanent vs. irreversible cessation of circulatory function • Necessary conditions for permanent cessation of circulatory function • Interference by resuscitation technologies • Differences in death determination in organ donors

  4. Concepts of uDCDD • Four clinical circumstances • Two studies failed to recruit donors • Prior reports were consented BD or DCD donors • Hard to extrapolate European experience to the United States

  5. Applications of Principles to uDCDD • UDCDD donor must have permanent cessation of circulation • Auto-resuscitation is an empirical question • Permanent cessation of circulation is death because it destroys the brain • Reperfusion technologies can retroactively invalidate the death determination unless the brain is not perfused

  6. Relationship between Circulation and Brain Function • Circulatory-respiratory criterion of death is a hybrid of circulatory and brain functions • Brain circulation stops when systemic circulation stops • Cessation of breathing is tightly linked to cessation of circulation in the absence of resuscitation • Timeline

  7. Circulatory Cessation to Death

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