Cardiac death criterion

The cardiac death criterion is a regulation of donation after cardiac death (DCD) - formerly called non-heart-beating donation (NHBD, English for "donor whose heart is not beating"). It was introduced as a death criterion in connection with organ harvesting for organ transplants in the late 1970s.

In Germany, brain death is used as a death criterion in connection with organ removal .

Maastricht Protocol

DCD is based on the Maastricht protocol (Maastricht classification):

In the 1980s, a donation program with cardiac deaths was started at the Maastricht University Hospital. The experience gained was incorporated into the requirements of the Maastricht Protocol of 1995. This classifies organ donors after cardiac arrest as follows:

category	definition	status
I.	Cardiac arrest on arrival at the clinic	uncontrolled cardiac arrest
II	Cardiac arrest after unsuccessful resuscitation	uncontrolled cardiac arrest
III	When cardiac arrest is expected and life support is interrupted	U.Ncontrolled cardiac arrest
IV	Cardiac arrest in brainstem death	uncontrolled cardiac arrest
V	Cardiac arrest in an inpatient	uncontrolled cardiac arrest

Category V was introduced in 2000.

• Categories I, II, IV and V are referred to as "uncontrolled" because the cardiac arrest naturally occurred.
• Category I donors are only allowed to collect tissue with long-lived cells, such as heart valves and corneas.
• Category II donors are patients whose resuscitation was unsuccessful outside the hospital. Only the kidneys are allowed to be removed from them for organ transplantation, but they must be carefully checked, otherwise the failure rate is high.
• Category III donors are patients with non-survivable injuries who have refrained from further treatment in this case by means of an advance directive and have made themselves available in writing as organ donors. The category is referred to as "controlled" because the cardiac arrest is awaited under controlled conditions after life-sustaining measures have been switched off and then death is declared immediately and organs can be removed immediately.
• Category III, IV and V donors may be able to transplant all organs with the exception of the heart - depending on the state of health of the respective organ.
• Liver and lungs can only be used for transplantation from controlled Category III donors.

Votes against

In their joint declarations from 2014 and 2015, several medical societies ( DGN , DGNC and DGNI ) speak out against the introduction of the DCD in Germany, “because it carries a higher risk of misdiagnosis”.

The German Ethics Council and the German Bishops' Conference are against the introduction of the DCD in Germany.

Individual evidence

1. ^ Rober Steinbrook: Organ Donation after Cardiac Death , accessed December 15, 2017
2. ↑ FAZ: Herztod - faz.net , accessed on December 15, 2017
3. ↑ Swisstransplant No. 5 September 2009 (PDF, 3.90 MB), accessed on December 15, 2017
4. ↑ Joint statement of the DGN, DGNC and DGNI on the determination of brain death before organ removal (PDF, 163.76 kB), accessed on December 15, 2017
5. ↑ German Ethics Council: Organ donation - yes or no? - Vatican Radio , accessed December 15, 2017