REVIEWThe ethics of donation after circulatory death organ recovery: an overview of new considerations arising from procurement practice and policy changesThiessen, Carriea; Gordon, Elisa J.b; Kelly, Beauc; Wall, Anjid Author Information aDepartment of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin bDepartment of Surgery, and Center for Biomedical Ethics & Society, Vanderbilt University Medical Center, Nashville, Tennessee cSDCI Donor Services, West Sacramento, California dDivision of Abdominal Transplantation, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA Correspondence to Carrie Thiessen, Assistant Professor, Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue | H4/784 CSC, Madison, WI 53792-7375, USA. Tel: +1 608 263 9903; e-mail: [email protected] Current Opinion in Organ Transplantation ():10.1097/MOT.0000000000001046, December 28, 2022. | DOI: 10.1097/MOT.0000000000001046 Buy PAP Metrics Abstract Purpose of review The aim of this study is to examine ethical issues raised by organ recovery from donors after circulatory death (DCD). Recent findings Recent technological developments and policy modifications have implications for evolving ethical issues related to DCD organ procurement and donation. We identify four such changes and discuss the most significant ethical issues raised by each: the use of cardiac perfusion machines and the need to develop criteria to allow prioritization for organ preservation in joint thoracic-abdominal procurements, normothermic regional perfusion and the irreversibility criterion in the definition of death, practice variability in DCD withdrawal of care and death declarations, and equitable access to donation, and changes in organ procurement organization evaluation metrics and transplant system resource utilization. Summary The evolution of DCD donation raises new ethical concerns that require further analysis to ensure that deceased donors, donor families and transplant recipients are treated respectfully and equitably. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.