Between a Rock and a Hard Place: Terminating Cardiopulmonary Resuscitation and Preserving Opportunities for Organ Donation
Authors: Joanna L. Hart, Scott D. Halpern
Journal: Annals of Internal Medicine (2016)

Editorials6 December 2016Between a Rock and a Hard Place: Terminating Cardiopulmonary Resuscitation and Preserving Opportunities for Organ DonationJoanna L. Hart, MD, MS and Scott D. Halpern, MD, PhDJoanna L. Hart, MD, MSFrom Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author and Scott D. Halpern, MD, PhDFrom Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2056 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Of the more than 300 000 out-of-hospital cardiac arrests (OHCAs) that occur annually in the United States, approximately 90% result in death (1). Prolonged resuscitation attempts may harm patients, family members, and those performing or witnessing the resuscitation. These adverse consequences may arise after resuscitative efforts in the field or en route to or in the emergency department. However, termination of resuscitation outside the hospital forecloses opportunities for organ donation. Advances in uncontrolled donation after cardiac death (UDCD) make successful organ recovery feasible if resuscitation is continued. Hence, society has interests not only in terminating resuscitative efforts that will not restore ...References1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-322. [PMID: 25520374] doi:10.1161/CIR.0000000000000152 CrossrefMedlineGoogle Scholar2. Mancini ME, Diekema DS, Hoadley TA, Kadlec KD, Leveille MH, McGowan JE, et al. Part 3: Ethical Issues: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S383-96. [PMID: 26472991] doi:10.1161/CIR.0000000000000254 CrossrefMedlineGoogle Scholar3. Jabre P, Bougouin W, Dumas F, Carli P, Antoine C, Jacob L, et al. Early identification of patients with out-of-hospital cardiac arrest with no chance of survival and consideration for organ donation. Ann Intern Med. 2016;165:770-8. doi:10.7326/M16-0402 LinkGoogle Scholar4. Wall SP, Kaufman BJ, Williams N, Norman EM, Gilbert AJ, Munjal KG, et al; NYC uDCDD Study Group. Lesson from the New York City out-of-hospital uncontrolled donation after circulatory determination of death program. Ann Emerg Med. 2016;67:531-537. [PMID: 26626335] doi:10.1016/j.annemergmed.2015.09.017 CrossrefMedlineGoogle Scholar5. Halpern SD. Donation after circulatory determination of death: time for transparency [Editorial]. Ann Emerg Med. 2014;63:401-3. [PMID: 24210366] doi:10.1016/j.annemergmed.2013.09.020 CrossrefMedlineGoogle Scholar6. Ortega-Deballon I, Hornby L, Shemie SD. Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes. Crit Care. 2015;19:268. [PMID: 26104293] doi:10.1186/s13054-015-0985-7 CrossrefMedlineGoogle Scholar7. Gries CJ, White DB, Truog RD, Dubois J, Cosio CC, Dhanani S, et al; American Thoracic Society Health Policy Committee. An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death. Am J Respir Crit Care Med. 2013;188:103-9. [PMID: 23815722] doi:10.1164/rccm.201304-0714ST CrossrefMedlineGoogle Scholar8. Hart JL, Harhay MO, Gabler NB, Ratcliffe SJ, Quill CM, Halpern SD. Variability among US intensive care units in managing the care of patients admitted with preexisting limits on life-sustaining therapies. JAMA Intern Med. 2015;175:1019-26. [PMID: 25822402] doi:10.1001/jamainternmed.2015.0372 CrossrefMedlineGoogle Scholar9. Bernat JL, Capron AM, Bleck TP, Blosser S, Bratton SL, Childress JF, et al. The circulatory-respiratory determination of death in organ donation. Crit Care Med. 2010;38:963-70. [PMID: 20124892] doi:10.1097/CCM.0b013e3181c58916 CrossrefMedlineGoogle Scholar10. Halpern SD, Truog RD. Organ donors after circulatory determination of death: not necessarily dead, and it does not necessarily matter [Editorial]. Crit Care Med. 2010;38:1011-2. [PMID: 20168173] doi:10.1097/CCM.0b013e3181cc1228 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2056.Corresponding Author: Joanna L. Hart, MD, MS, University of Pennsylvania, Blockley Hall 734, 423 Guardian Drive, Philadelphia, PA 19104.Current Author Addresses: Dr. Hart: University of Pennsylvania, Blockley Hall 734, 423 Guardian Drive, Philadelphia, PA 19104.Dr. Halpern: University of Pennsylvania, Blockley Hall 719, 423 Guardian Drive, Philadelphia, PA 19104.This article was published at www.annals.org on 13 September 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEarly Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation Patricia Jabre , Wulfran Bougouin , Florence Dumas , Pierre Carli , Corinne Antoine , Laurent Jacob , Benjamin Dahan , Frankie Beganton , Jean-Philippe Empana , Eloi Marijon , Nicole Karam , Alexandre Loupy , Carmen Lefaucheur , Daniel Jost , Alain Cariou , Frédéric Adnet , Thomas D. Rea , and Xavier Jouven Metrics Cited byCoding the Dead: Cardiopulmonary Resuscitation for Organ PreservationDeclare Death or Attempt Experimental Resuscitation? 6 December 2016Volume 165, Issue 11Page: 820-821KeywordsCardiopulmonary resuscitationConfidence limitDisclosureEmergency departmentEmotionsHeartMortalityOrgan transplantationPatientsResuscitation ePublished: 13 September 2016 Issue Published: 6 December 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. 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