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Defining the vital condition for organ donation

DOI: 10.1186/1747-5341-2-27

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In the last 40 years, transplantation has become an effective therapy for end-stage organ failure. The vast majority of viable organs are retrieved from patients who, according to the dead donor rule, are considered to be dead because of irreversible cessation of either cardiac and respiratory function or all brain function [1]. Unfortunately, the definition of the vital status of organ donors has been challenged both for donation after cardiac death (DCD) [2-4] and for brain death (BD) [5-7]As for DCD, Verheijde and colleagues now propose a "paradigm change to ensure the legitimacy of DCD practice", which should include societal and legal abandonment of the dead donor rule and mandated choice in order to promote individual participation and to specify personal decision about organ donation [8]. This approach requires careful consideration and discussion.The proposal of abandonment of the dead donor rule, "a switch in the ethics of organ procurement from donor beneficence to autonomy and non maleficence", is not new. As for BD, Truog proposed redefining the condition permitting the retrieval of vital organs in terminal but still living persons: "This alternative [ethical framework] is based not on brain death and the dead-donor rule, but on the ethical principles of non-maleficence (the duty not to harm, or primum non nocere) and respect for persons. We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donate their organs, without first being declared dead. Advantages of this approach are that (unlike the dead-donor rule) it focuses on the most salient ethical issues at stake, and (unlike the concept of brain death) it avoids conceptual confusion and inconsistencies" [7].We believe that the societal acceptability of such position remains questionable.The main problem is that this position is still based on the strict dichotomy between life and death, according to which, if

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