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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Ethical controversies in organ donation after circulatory death
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Ethical controversies in organ donation after circulatory death

机译：循环系统死亡后器官捐赠的伦理争议

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The persistent mismatch between the supply of and need for transplantable organs has led to efforts to increase the supply, including controlled donation after circulatory death (DCD). Controlled DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria. Two central ethical issues in DCD are when organ recovery can begin and how to manage conflicts of interests. The "dead donor rule" should be maintained, and donors in cases of DCD should only be declared dead after the permanent cessation of circulatory function. Permanence is generally established by a 2- to 5-minute waiting period. Given ongoing controversy over whether the cessation must also be irreversible, physicians should not be required to participate in DCD. Because the preparation for organ recovery in DCD begins before the declaration of death, there are potential conflicts between the donor 's and recipient 's interests. These conflicts can be managed in a variety of ways, including informed consent and separating the various participants' roles. For example, informed consent should be sought for premortem interventions to improve organ viability, and organ procurement organization personnel and members of the transplant team should not be involved in the discontinuation of life-sustaining treatment or the declaration of death. It is also important to emphasize that potential donors in cases of DCD should receive integrated interdisciplinary palliative care, including sedation and analgesia. Pediatrics 2013;131:1021-1026
机译：可移植器官的供应与需求之间的持续不匹配导致人们努力增加供应，包括在循环系统死亡（DCD）之后进行受控捐赠。受控DCD涉及计划中的维持生命治疗的退出以及根据心肺标准宣布死亡后的器官恢复。 DCD中的两个核心伦理问题是何时开始器官恢复以及如何处理利益冲突。应维持“死者捐献者规则”，只有在永久停止循环功能后才宣布DCD病例中的捐献者死亡。持久性通常是通过2至5分钟的等待时间来确定的。鉴于是否停止也必须是不可逆的仍存在争议，因此不应要求医师参加DCD。由于DCD器官恢复的准备工作是在宣布死亡之前开始的，因此在捐赠者和接受者的利益之间可能存在冲突。可以通过多种方式管理这些冲突，包括知情同意和分离各个参与者的角色。例如，应进行知情同意以进行死前干预，以提高器官的生存能力，器官采购组织人员和移植小组成员不应参与终止生命维持治疗或宣布死亡。还必须强调，DCD病例中的潜在供体应接受综合的跨学科姑息治疗，包括镇静和镇痛。儿科2013; 131：1021-1026

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