"Cardiac Transplantation following DCD should be an Oxymoron." -Mike O'Connor.
As the saying goes, "you can't make this stuff up." This is in reference, of course, to the recent NEJOM article entitled Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death. In this study, two infants had their hearts harvested following 75 seconds of asystole. The very first post of this blog was titled with a Thoreau quote; "Distrust any enterprise which requires new Clothes." That might be aptly rephrased in the present instance to "Distrust any behaviors which require new ethical language." Obviously, here, Donation after Cardiac Death would be a misnomer, since the heart is nothing like dead, so the designation has been quietly and not-so-subtly modified to cardio-circulatory death. This seems like a further slippery step along the path to a utilitarian transformation of the ethical calculus of donation. Initially, when Beecher et al advanced the definition of brain death, the inevitability of corporal death was a given. Then, in response to a shortage of organs, the line was moved to allow the hastening of death through Donation after cardiac death. Make no mistake, this new designation of cardio-circulatory death, and its ethical rationale represents a fundamental shift again, towards a paradigm of "relative" utility; the implicit argument is that the recipient can make better use of the organ than the donor. This all takes place under the cover of compact between the donor's guardian, the recipient, and the intermediary technicians (transplant surgeon, etc.)