On the ethical permissibility of reperfusion in cardiac transplantation after the declaration of circulatory death.

Transplant surgeons in the USA have begun performing a novel organ procurement protocol in the setting of circulatory death. Unlike traditional donation after circulatory death (DCD) protocols, normothermic perfusion DCD involves reperfusing organs, including the heart, while still contained in the donor body. Some commentators, including the American College of Physicians, have claimed that reperfusion after circulatory death violates the widely accepted Dead Donor Rule (DDR) and conclude that reperfusion is ethically impermissible. In this paper I argue that, in terms of respecting the DDR, reperfusion cardiac transplantation does not differ from traditional DCD cardiac transplantation. I do this by introducing and defending a refined conception of circulatory death, namely I also argue against the controversial brain occlusion feature of the reperfusion DCD protocol, on the basis that it is ethically unnecessary and generates the problematic appearance of ethical dubiousness.