The organ donation boom complicates the boundary between life and death. Emily Hoffman, a 34-year-old woman, died in February 2023 after a car accident. Her donation followed a different path, one that has transformed American transplantation in the last decade. It is called donation after circulatory death (DCD), where death is declared after circulation ceases and the heart stops beating. This method has become more prevalent, accounting for nearly half of all organ donors who have died in the United States. Hoffman's donation improved several lives at once, saving two men's lives with her kidneys, a third recipient's life with her liver, and her corneas helping a nine-month-old baby gain sight.
The breakthrough in organ donation is the mechanical ventilator, developed in the 1950s, which can keep a body breathing and its heart beating even after the brain has stopped. This created a situation where patients were deceased by older measures, but their organs were still functional. The legal lines between life and death were also clearly defined in 1968, with a Harvard committee proposing a definition of brain death. By 1981, a model law recognized two ways of legal death: circulatory death or brain death.
The DCD boom grew out of the desperation of organ shortages, presenting the possibility of donation in more common cases of death. Technological advancements, such as new machines that can keep organs alive outside the body, have made DCD more viable. Policy changes have also played a role, with organ procurement organizations (OPOs) being ranked against one another and penalized for poor performance. However, the rise of DCD has also raised questions about medicine's ability to manage the boundary between life and death.
The controversy surrounding DCD involves the use of normothermic regional perfusion (NRP), a technique that restores circulation inside the dead donor's body before the organs are removed. This raises ethical concerns about the potential for pain or suffering in the procurement of the organs. The future of DCD depends on its proponents' ability to protect both patients and public trust.
