of recent conferences and major reports. It then examines general ethical considerations, before focusing on the ethical issues specific to controlled and to uncontrolled DCDD. Because uncontrolled DCDD has not been fully explored, the chapter provides an estimate of the potential number of donors as well as outlining major challenges in moving forward in this area. An additional group of potential donors are those with age or medical characteristics outside of the standard criteria for organ donation. Issues relevant to expanded criteria donors are discussed. The chapter concludes with the committee’s recommendations on DCDD and expanded criteria donation.

BACKGROUND AND ISSUES

Determination of Death

The fundamental tenet of organ donation is the dead donor rule, that is, that organ donation should not cause or hasten death (Robertson, 1999). As discussed in Chapter 1, the advent of external ventilation technologies and other technological advances led to the development of criteria for neurologic determination of death (based on the irreversible loss of function of the whole brain, including the brain stem) and to clarification of criteria for circulatory determination of death (irreversible cessation of circulatory function) (Report of the Ad Hoc Committee, 1968; President’s Commission, 1981).

However, the terminology that has arisen, specifically, the terms brain death and cardiac death, has often been misunderstood and thought to imply only the death of an organ—either the brain or the heart—and not the death of the human being. The committee believes that it is particularly important to clarify the terms that are used so that it is fully understood that death can be declared or determined by a physician either by the use of neurologic criteria or by the use of circulatory criteria.

When it is necessary to distinguish between the ways in which death is determined, the committee suggests using the terms neurologic determination of death (NDD) or circulatory determination of death (CDD). In either case, organ donation occurs only after death. Because different kinds of protocols and procedures are used to recover organs from individuals who have died according to these two criteria, it is useful to distinguish between donation in these different contexts. The committee recommends a change in terminology to donation after neurologic determination of death (DNDD) and donation after circulatory determination of death (DCDD).1 The com-

1

Donation after circulatory determination of death was previously termed “non-heart-beating donation” or “donation after cardiac death.”



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