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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2013 May;79(5):534-40
Donation after cardiac death: is a “paradigm shift” feasible in Italy?
Fanelli V. 1, Geraci P. M. 2, Mascia L. 1 ✉
1 Dipartimento di Anestesiologia e Rianimazione, Università di Torino, A.O. Città della Salute e della Scienza - Ospedale S. Giovanni Battista-Molinette, Torino, Italy;
2 Transplant Coordination Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Donation after cardiac death (DCD) is one of the growing strategies to overcome the problem of organ shortage. Cardiac death is defined as “irreversible cessation of circulatory and respiratory function”; the time interval to define irreversibility of cardiac death, the peculiarity of consent, and the framework of end-of-life decision making are the most compelling ethical issues which have been raised with DCD. National protocols that balance medical, ethical, and social issues are mandatory to guide transplant care professionals. In Italy, the 20 min cardiac arrest demonstrated by continuous electrocardiography recording is the time interval necessary for death diagnosis based on cardiopulmonary criteria. This time negatively affects donation after cardiac death because warm ischemic time (WIT) – the most important predictor of grafts’ poor outcome – is prolonged. However, this time seems to be prudential to define the irreversibility of death and to respect the “dead donor rule”, as established by the National Committee of Bioethics. National reference protocols regulating DCD practice are therefore a compelling issue.