Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death
Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death
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DOI：
10.1111/ajt.13792
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发表时间：
2016-08-01
影响因子：
8.8
通讯作者：
Bernat, J. L.
中科院分区：
文献类型：
--
作者：
Ave, A. L. Dalle;Shaw, D. M.;Bernat, J. L.
使用供体体外膜肺氧合（ECMO）来改善移植物结局，通过一些循环确定死亡（cDCDD）计划后的控制性捐献，引起了伦理问题。我们回顾了使用ECMO的cDCDD方案和相关伦理文献，以分析这些问题。ECMO在cDCDD中改善移植物结局并不明显。在我们看来，在死亡前实施ECMO可能会干扰临终关怀并损害身体完整性。通过恢复体循环，如果由于横膈上主动脉闭塞球囊的故障或错位而没有充分排除脑和心脏灌注，ECMO有可能使先前的死亡声明无效。ECMO的使用与首字母缩略词DCDD不兼容，因为循环在确定死亡后恢复。由于这些缺陷，我们得出结论，其他技术是更可取的，如快速恢复或原位冷灌注。如果进行ECMO，它需要一个具体的知情同意和透明度。作者分析了使用体外膜肺氧合在控制捐赠后，循环确定死亡协议提出的伦理问题。
The use of donor extracorporeal membrane oxygenation (ECMO) to improve graft outcomes by some controlled donation after circulatory determination of death (cDCDD) programs raises ethical issues. We reviewed cDCDD protocols using ECMO and the relevant ethics literature to analyze these issues. It is not obvious that ECMO in cDCDD improves graft outcomes. In our opinion, ECMO implemented before death can interfere with end-of-life care and damage bodily integrity. By restoring systemic circulation, ECMO risks invalidating the preceding declaration of death if brain and cardiac perfusion is not adequately excluded because of malfunction or misplacement of the supradiaphragmatic aortic occlusion balloon. The use of ECMO is not compatible with the acronym DCDD because circulation is restored after the determination of death. Because of these deficiencies, we concluded that other techniques are preferable, such as rapid recovery or in situ cold infusion. If ECMO is performed, it requires a specific informed consent and transparency.The authors analyze the ethical issues raised by the use of extracorporeal membrane oxygenation in controlled donation after circulatory determination of death protocols.