ETHICAL CONSIDERATIONS OF ALLOCATION: Edited by David A. AxelrodUncontrolled donation after circulatory death: ethics of implementationMolina, Maríaa,d,e; Domínguez-Gil, Beatrizb; Pérez-Villares, José M.f; Andrés, Amadoa,cAuthor Information aDepartment of Nephrology, Hospital Universitario ‘12 de Octubre’ bOrganización Nacional de Trasplantes cInstituto de Investigación Hospital ‘12 de Octubre’ (imas12), Madrid dDepartment of Nephrology, Hospital Universitario Arnau de Vilanova eInstitut de Recerca Biomèdica, Lleida fCoordinación Sectorial de Trasplantes de Granada, Servicio de Medicina Intensiva Hospital Universitario Virgen de las Nieves, Granada, Spain Correspondence to María Molina, PhD, Department of Nephrology, Hospital Universitario ‘12 de Octubre’, Avda. de Córdoba, s/n, 28041 Madrid, Spain. Tel: +34 913908000; fax: +34 914695775; e-mail: [email protected] Current Opinion in Organ Transplantation: June 2019 - Volume 24 - Issue 3 - p 358-363 doi: 10.1097/MOT.0000000000000648 Buy Metrics Abstract Purpose of review Despite its potential to increase the donor pool, uncontrolled donation after circulatory death (uDCD) is available in a limited number of countries. Ethical concerns may preclude the expansion of this program. This article addresses the ethical concerns that arise in the implementation of uDCD. Recent findings The first ethical concern is that associated with the determination of an irreversible cardiac arrest. Professionals must strictly adhere to local protocols and international standards on advanced cardiopulmonary resuscitation, independent of their participation in an uDCD program. Cardiac compression and mechanical ventilation are extended beyond futility during the transportation of potential uDCD donors to the hospital with the sole purpose of preserving organs. Importantly, potential donors remain monitored while being transferred to the hospital, which allows the identification of any return of spontaneous circulation. Moreover, this procedure allows the determination of death to be undertaken in the hospital by an independent health care provider who reassesses that no other therapeutic interventions are indicated and observes a period of the complete absence of circulation and respiration. Extracorporeal-assisted cardiopulmonary resuscitation programs can successfully coexist with uDCD programs. The use of normothermic regional perfusion with ECMO devices for the in-situ preservation of organs is considered appropriate in a setting in which the brain is subject to profound and prolonged ischemic damage. Finally, communication with relatives must be transparent and accurate, and the information should be provided respecting the time imposed by the family's needs and emotions. Summary uDCD can help increase the availability of organs for transplantation while giving more patients the opportunity to donate organs after death. The procedures should be designed to confront the ethical challenges that this practice poses and respect the values of all those involved. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.