Diagnosis of Brain Death and Organ Donation After Circulatory Death
Determination of death and provision of organ transplantation can result in controversy for the pediatric provider caring for a critically ill or injured child. Despite accepted legal definitions for death and guidelines for neurologic and circulatory determination of death, there remains an evolving and, at times, contentious dialogue among medical experts and the community. We provide the historical context and summarization of several legal and clinical aspects to define death and discussion of potential ethical controversies regarding death by neurologic and circulatory criteria. We highlight conflicts and controversies raised by both family and healthcare team members that are becoming increasingly prevalent in our practice of critical care medicine. We offer insight and proposed solutions into matters of autonomy, maleficence, non-beneficence, and the respectful, dignified care of the sick and dying child and their family.
KeywordsBrain death Donation after neurologic determination of death Donation after circulatory determination of death Ethics Pediatric Critical Care Medicine
American Academy of Pediatrics
Donation after circulatory determination of death
Donation after neurologic determination of death
Do not resuscitate
Organ procurement organization
Pediatric intensive care unit
Society of Critical Care Medicine
Uniform Anatomical Gift Act
Uniform Determination of Death Act
Withdrawal of life-sustaining therapies
Conflict of Interest
Dr. Sochet: None
Dr. Nakagawa: Received funding from Up To Date and Fresenius Kabi. Dr. Nakagawa is the Assistant Medical Director for Carolina Donor Services.
Ms. Glazier: None
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