Indian Journal of Transplantation (Sep 2024)

Organ Donation after Circulatory Determination of Death - Consensus Statement

  • Avnish Kumar Seth,
  • Ravi Mohanka,
  • Raj Kumar Mani,
  • Sonal Asthana,
  • Sandeep Attawar,
  • Kumud K. Dhital,
  • Deepak Gupta,
  • Roop Gursahani,
  • Milind Hote,
  • Anil Kumar,
  • Krishan Kumar,
  • Vivek B. Kute,
  • Surendra Kumar Mathur,
  • Dhvani Mehta,
  • Darius F. Mirza,
  • Pranjal Modi,
  • Rahul Anil Pandit,
  • Ashish Sharma,
  • Sunil Shroff

DOI
https://doi.org/10.4103/ijot.ijot_37_24
Journal volume & issue
Vol. 18, no. 3
pp. 247 – 256

Abstract

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Organ donation after circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries, most commonly being category III-controlled donations. This document, prepared by a multidisciplinary group of experts, describes the feasibility of category III DCDD in India, in view of the January 2023 Supreme Court (SC) judgment simplifying the process of withdrawal of life-sustaining treatment (WLST). The paper discusses the concept and types of futility of care, how to elicit patients values and wishes, outlines its determination in several clinical situations and the process of WLST in such cases, in accordance with the SC judgement. The judgement mandates evaluation for futility of care by the primary and secondary medical boards before intimation to the judicial magistrate and WLST. The paper also discusses the use of new and upcoming organ preservation techniques and technologies in various organ transplants and outcomes of such transplants. We have also reviewed international best practices in cDCDD, discuss the ethical, medical, legal, economic, procedural, and logistic challenges in India and outline a path for DCDD in India. The manuscript discusses and compares the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand-down and return to the intensive care unit (ICU) without donation. Further clarifications of aspects such as ante-mortem measures and do-not attempt resuscitation (DNAR) may be required during implementation of the judgement in some situations.

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