The Ethics of Heart Donation After the Circulatory Determination of Death: Gaps in Knowledge and Research Opportunities

In 2023, the National Heart, Lung, and Blood Institute (NHLBI) organized a workshop to identify research gap areas in organ donation after circulatory determination of death (DCDD). We present the findings of the DCDD ethics working group. Heart DCDD, as all DCDD, may disrupt optimal end-of-life care. Irrespective of organ donation, research opportunities include identifying which processes of withdrawal of life-sustaining therapy offer optimum patient comfort, how best to ensure patient comfort at the end of life, and how to better understand patients' preferences for end-of-life care. Whether heart DCDD breaches the Dead Donor Rule (DDR) depends on its interpretation, the validity and rationale of the determination of death, and the DCDD protocol used. Further research could clarify the interpretation of the DDR, the concept and determination of death, the time the cessation of brain function ensures that the patient is beyond neuro-cognitive harm, the implications of thoracoabdominal normothermic regional perfusion on the determination of death and on brain functions, and the type of consent and level of information required for different DCDD techniques.