Was den Menschen zum Menschen macht

DCD Heart Donation

5 Min. Lesezeit

🇩🇪 Deutsche Version: Spende des Herzens nach Kreislaufstillstand

DCD heart donation is the Donation after Circulatory Death of the heart — in terms of substance ontology and ethics the paradigmatically problematic variant of donation after circulatory death.

Three reasons make it the sharpest form in the debate over donation after circulatory death:

First: The heart is a strictly unpaired organ. A living organ donation is not possible — the whole ethical burden falls upon postmortem donation.

Second: Under the permanence standard, a heart is transplanted whose function is resumed in the recipient after transplantation. Critics (Bernat, Veatch) judge this finding to be self-contradictory: if the heart can resume its function, then its function was evidently not ended in the substance-ontologically strong sense.

Third: The NRP variant — especially thoracoabdominal NRP (TA-NRP) — intensifies the problem through additional causal interventions (clamping of the aortic arch).

International practice

DCD heart donation is currently practiced in 9 countries worldwide: Australia, Belgium, Italy, the Netherlands, Austria, Spain, Switzerland, the United Kingdom, and the USA.

Switzerland introduced DCD heart donation as regular practice in 2023. In the USA, by 2025 already 24 percent of all heart donations were donation after circulatory death — a rapidly growing figure since the first successful DCD heart transplantation in 2014 (Australia).

Self-contradictory logic?

The central tension of DCD heart donation can be precisely formulated:

  1. The permanence standard declares the heart, after 5 minutes of asystole, “not going to return.”
  2. The heart is removed.
  3. The heart is reactivated in the recipient — it resumes its pumping function.
  4. If the heart beats again after reactivation: how could it previously be declared “not going to return”?

Defenders of DCD heart donation (Truog 2024, Hastings Center Report) argue that permanence is not a property of the organ but a property in the context of the specific person: in the donor the heart would not have returned (because no resuscitation was attempted); in the recipient it beats again.

Critics (James Bernat, Robert Veatch, Don Marquis) counter that the organ’s capacity to function existed in the donor — otherwise it could not be reactivated in the recipient either. Permanence is thus a stipulation, not an ontological fact.

The substance-ontological position

The personal ontology defended here classifies DCD heart donation as the sharpest variant of donation after circulatory death: it potentially violates both the Dead Donor Rule and the personalist norm.

The reasoning: if the permanence of circulatory arrest is not substance-ontologically sufficient for certain death, and the heart can resume its function after transplantation, then DCD heart donation potentially violates the Dead Donor Rule. For strictly unpaired organs this violation is structurally unavoidable, because no living-donation alternative exists.

John Paul II prefigured the position magisterially (2000):

“Vital organs which occur singly in the body can be removed only after death, that is from the body of someone who is certainly dead.”

In the case of DCD heart donation this condition is not unambiguously met by substance-ontological standards — and this is precisely where the precautionary principle of Benedict XVI applies.

TA-NRP: a twofold intensification

In thoracoabdominal NRP (TA-NRP), the additional factor is that the clamping of the aortic arch — as a step of organ procurement — would be causally death-producing if the person is not definitively dead. This makes TA-NRP a direct (not merely potential) violation of the DDR.

The United Kingdom paused TA-NRP at the end of 2020 out of exactly this concern.

Ontological classification

Superordinate concept: Donation after Circulatory Death (variant: donation after circulatory death for unpaired organs)

Ontological relations:

Chapter assignment: Chapter 5: Oblivion of the Person (German), Chapter 4: Personhood (German)

Sources

Practice and statistics

  • Joshi, Yashutosh; Wang, Katherine; MacLean, Campbell; Villanueva, Jeanette; Gao, Ling; Watson, Alasdair; Iyer, Arjun; Connellan, Mark; Granger, Emily; Jansz, Paul; Macdonald, Peter (2024): The Rapidly Evolving Landscape of DCD Heart Transplantation. Current Cardiology Reports 26: 1499—1507.
  • Changes in Organ Donation after Circulatory Death in the United States (2025), PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12947068/
  • Swisstransplant (2023): Introduction of DCD heart donation in Switzerland.

Ethical discussion

  • Truog, Robert D. (2024): In Defense of Normothermic Regional Perfusion. Hastings Center Report 54(4): 24—31.
  • Bernat, James L. (2013): Controversies in defining and determining death in critical care. Nature Reviews Neurology 9(3): 164—173.
  • Veatch, Robert M.; Ross, Lainie F. (2016): Defining Death: The Case for Choice. Washington: Georgetown University Press.
  • Marquis, Don (2010): Are DCD donors dead? Hastings Center Report 40(3): 24—31.
  • Joffe, Ari R. et al. (2011): Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent. Philosophy, Ethics, and Humanities in Medicine 6: 17.

Magisterial support

See also

Generated by querying the Personhood ontology.

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