Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent

There have been many "consensus" statements addressing the practice of donation after cardiocirculatory death (DCD). In general, these claim that DCD conforms to clear ethical principles, respects the dead donor rule, and is worthy of support [1-5]. Many believe that the ethical problems of DCD have been "worked out" and that it is unclear why DCD should be resisted. The dead donor rule is an "unwritten, uncodified standard that has guided organ procurement in the United States since the late 1960s" [6]. This rule claims that humans must be dead before vital organs can be taken, and is intended to prevent the following: patients being killed by organ retrieval, harm or exploitation of the weak/vulnerable, mistrust of doctors and transplantation, and treating a patient merely as a means to organs [6,7].We argue for a moratorium on the practice of DCD until full public disclosure and fully informed consent is obtained from potential donors. Specifically, we will argue that DCD donors may not yet be dead, conflicts of interest in the decision to withdraw life support before DCD are unavoidable, potentially harmful premortem interventions during DCD cannot be justified even with the rule of double effect, consensus statements are of low quality and plagued by conflict of interest, and that claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the substantial benefit of organ donation.In general, the current practice of controlled DCD can be summarized as follows [1-5]. First, there is a decision based on the patient's wishes (either directly, or via a substitute decision maker) or best interests (via a guardian surrogate decision maker when the patient's wishes either are not known, or the patient was never competent) to discontinue life support therapy. This is typically made in the situation of severe brain