Editing Do not resuscitate (section)

=== Controlled organ donation after circulatory death ===
In 2017, Critical Care Medicine (Ethics) and the American Society of Anesthesiologists (ASA) Committees on Transplant Anesthesia issued a statement regarding organ donation after circulatory death (DCD).<ref name="asahq.org">{{Cite web |title=Statement on Controlled Organ Donation After Circulatory Death |url=https://www.asahq.org/standards-and-guidelines/statement-on-controlled-organ-donation-after-circulatory-death |access-date=2022-09-12 |website=www.asahq.org}}</ref> The purpose of the statement is to provide an educational tool for institutions choosing to use DCD. In 2015, nearly 9% of organ transplantations in the United States resulted from DCD, indicating it is a widely-held practice. According to the President's Commission on Death Determination, there are two sets of criteria used to define circulatory death: irreversible absence of circulation and respiration, and irreversible absence of whole brain function. Only one criterion needs to be met for the determination of death before organ donation and both have legal standing, according to the 1980 Uniform Determination of Death Act (UDDA); a determination of death must be according to accepted medical standards.<ref>{{Cite web |title=Determination of Death Act - Uniform Law Commission |url=https://www.uniformlaws.org/committees/community-home?CommunityKey=155faf5d-03c2-4027-99ba-ee4c99019d6c#:~:text=Description&text=The%20Uniform%20Determination%20of%20Death,or%20the%20right%20to%20die. |access-date=2022-09-12 |website=www.uniformlaws.org |language=en}}</ref> All states within the United States adhere to the original or modified UDDA. The dead donor role states that a patient should not be killed for or by the donation of their organs and that organs can only be procured from dead people (lungs, kidneys, and lobes of a liver may be donated by living donors in certain highly regulated situations).

The definition of irreversibility centers around an obligatory period of observation to determine that respiration and circulation have ceased and will not resume spontaneously. Clinical examination alone may be sufficient to determine irreversibility, but the urgent time constraints of CDC may require more definitive proof of cessation with confirmatory tests, such as intra-arterial monitoring or Doppler studies. In accordance with the Institute of Medicine, the obligatory period for DCD is longer than 2 minutes but no more than 5 minutes of absent circulatory function before pronouncing the patient dead, which is supported by a lack of literature indicating that spontaneous resuscitation occurs after two minutes of arrest and that ischemic damage to perfusable organs occurs within 5 minutes.<ref>{{Cite book |last=Institute of Medicine (US) Committee on Non-Heart-Beating Transplantation II: The Scientific and Ethical Basis for Practice and Protocols |url=http://www.ncbi.nlm.nih.gov/books/NBK225025/ |title=Non-Heart-Beating Organ Transplantation: Practice and Protocols |date=2000 |publisher=National Academies Press (US) |isbn=978-0-309-06641-9 |location=Washington (DC) |pmid=25077239}}</ref>

Most patients considered for DCD will have been in the intensive care unit (ICU) and are dependent on ventilatory and circulatory support. Potential DCD donors are still completing the dying process but have not yet been declared dead, so quality end-of-life care should remain the absolute top priority and must not be compromised by the DCD process. The decision to allow death to occur by withdrawing life-sustaining therapies needs to have been made in accordance to the wishes of the patient and/or their legal agent; this must happen prior to any discussions about DCD, which should ideally occur between the patient's primary care giver and the patient's agent after rapport has been established.<ref name="asahq.org"/>