Purpose of review: The present review will provide anesthesiologists with the scientific information and ethical arguments they need to make decisions about donation after cardiac death (DCD) for their clinical practices.
Recent findings: Organs derived from DCD benefit patients who would otherwise die without transplantation. The practice of DCD ties the withdrawal of life support to organ donation. The close approximation of cessation of circulation to the recovery of organs demands a systematically structured approach to ensure that patient care at the end of life will not be sacrificed for organ donation. In response, the medical community has developed standards of care through expert opinion and consensus. There is general agreement that patients are entitled to expert care at the end of life whether or not they will be organ donors. Thus, abrupt transfer of patient care to an anesthesiologist is usually not in the best interest of the patient.
Summary: By 2007, all US hospitals will have protocols for DCD. Anesthesiologists should review existing protocols and participate in the development of new ones to ensure that the approach to DCD conforms to current standards and that patients have a designated care provider for the withdrawal of life support.