Page 42 - 2018EthEBK

Healthcare staff may be particularly uncomfortable at the
clinical interface between end-of-life care and organ
donation. These concerns include the perceived conflict of
interest for clinicians involved in both the decision to withdraw
treatments and any subsequent proposal for deceased donation,
even though none may exist. Other concerns relate to the
lawfulness and acceptability of interventions before or after
death necessary to facilitate DCD Donation after circulatory
death and uncertainties around the time at which death can be
confirmed using circulatory criteria. Such uncertainties include
the possibility of spontaneous return of the circulation after
asystole and lingering responsiveness of the nervous tissue to
restoration of cerebral blood flow. (A. R. Manara, etc.: British
Journal of Anaesthesia, Volume 108, Issue suppl_1, 1 January )

With further extensive exploration of “Controlled vs
Uncontrolled Cardiac-Death Organ Donation”, we may find
that there are still some cases that make us question about their
ethics. For example, in ECMO-assisted cardiac death organ
donation, balloon occlusion of descending aorta is used to
preclude reperfusion of the arrested heart and stops the
recovery of heart beating. Furthermore, in one case of” cardiac
death heart donation” in a certain country, the allegedly “dead”
heart was not actually dead because the heart could still recover
its beating. However, it was used as a donor heart to save
another terminal heart disease patient.

30 107 年度•醫學倫理•人文醫學•心得