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Circulatory Death Determination in

Uncontrolled Organ Donors

ACOT Meeting

March 7, 2013

James L. Bernat, M.D.

Louis and Ruth Frank Professor of Neuroscience

Professor of Neurology and Medicine

Geisel School of Medicine at Dartmouth


Progress Report 1

Paper went through eight revisions of

consensus points and three revisions of

manuscript

Panel decided that emergency medicine

journal was the best place to publish it because

ER physicians will do death determinations

Paper submitted to Annals of Emergency

Medicine on February 25, 2013


Progress Report 2

HRSA disclaimer added by HRSA attorneys

Three panelists declined to sign:

Prof. James Childress (agreed with findings but

was too busy to participate)

Dr. Douglas White and Dr. Scott Halpern

disagreed with some elements of the argument


Abstract 1

One barrier for implementing programs of

uncontrolled organ donation after the

circulatory determination of death is consensus

on the precise moment of death. Our panel was

convened to study this question after we

performed a similar analysis on the moment of

death in controlled organ donation after the

circulatory determination of death.


Abstract 2

We concluded that death could be determined

by showing the permanent or irreversible

cessation of circulation and respiration.

Circulatory irreversibility may be presumed

when optimal CPR efforts have failed to

restore circulation and the period has elapsed

thereafter during which auto-resuscitation to

restored circulation could occur.


Abstract 3

We advise against the use of post-mortem

organ support technologies that re-establish

circulation of warm oxygenated blood because

of their risk of retroactively invalidating the

required conditions upon which death was

declared.

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