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From a conceptual standpoint, it is important to note that one accepted standard for brain death is the absence of brain blood flow. Absence of whole body circulation invariably is accompanied by absent brain blood flow, thus conceptually fulfilling criteria for brain death.
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A major criticism of donation after circulatory death (DCD) protocols has been the concern regarding the time of observation to determine death and the possibility that death is irreversible within the time limits proposed.
Concerns are expressed about violating the dead donor rule, ethical compromise, and the theoretical medico-legal risks for practitioners of being accused of causing the death of a potential donor.
The majority of deaths in neonatal, pediatric, and adult intensive care are related to irrecoverable illness and are preceded by withdrawal or withholding of life-sustaining treatment (WLST). This is unacceptable ICU practice in most countries throughout the world, although there is considerable practice variation.
One of the principle obstacles to donation after circulatory death (DCD) development has been a concern about real and perceived conflicts of interests between providing care for a dying patient and facilitating donation before death has been established.
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