Document Detail

How the distinction between "irreversible" and "permanent" illuminates circulatory-respiratory death determination.
MedLine Citation:
PMID:  20439357     Owner:  NLM     Status:  MEDLINE    
The distinction between the "permanent" (will not reverse) and "irreversible" (cannot reverse) cessation of functions is critical to understand the meaning of a determination of death using circulatory-respiratory tests. Physicians determining death test only for the permanent cessation of circulation and respiration because they know that irreversible cessation follows rapidly and inevitably once circulation no longer will restore itself spontaneously and will not be restored medically. Although most statutes of death stipulate irreversible cessation of circulatory and respiratory functions, the accepted medical standard is their permanent cessation because permanence is a perfect surrogate indicator for irreversibility, and using it permits a more timely declaration. Therefore, patients properly declared dead in donation after circulatory death (DCD) protocols satisfy the requirements of death statutes and do not violate the dead donor rule. The acronym DCD should represent organ "donation after circulatory death" to clarify that the death standard is the permanent cessation of circulation, not heartbeat. Heart donation in DCD does not retroactively negate the donor's death determination because circulation has ceased permanently.
James L Bernat
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-05-03
Journal Detail:
Title:  The Journal of medicine and philosophy     Volume:  35     ISSN:  1744-5019     ISO Abbreviation:  J Med Philos     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-24     Completed Date:  2010-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610512     Medline TA:  J Med Philos     Country:  United States    
Other Details:
Languages:  eng     Pagination:  242-55     Citation Subset:  E; IM    
Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
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MeSH Terms
Bioethical Issues
Blood Circulation*
Brain Death / diagnosis,  physiopathology
Practice Guidelines as Topic
Tissue and Organ Procurement* / legislation & jurisprudence
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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