In 2017, 10,288 people in the United States donated organs after they died. Most were pronounced dead using brain criteria, but 1885 were declared dead the old-fashioned way (using circulatory criteria) because their hearts had stopped beating. They became so-called DCD or “donation after circulatory death” donors. When the heart stoppage indicates that circulation has ceased, the physician pronouncing death must wait to make sure that the heart will not spontaneously restart. Restarting is referred to as “autoresuscitation.” The waiting period (sometimes called the “no-touch period”) is often—but not always—based on the time needed to rule out autoresuscitation and is quite controversial. In practice it ranges from as little as 75 seconds, the time used in a controversial heart procurement from some newborns in Denver, CO, to as long as 20 minutes, the legally required “no-touch” period in Italy. The University of Pittsburgh protocol once recommended 2 minutes; the Institute of Medicine, 5 minutes.
DCD organ donation occurs in two ways: (1) controlled (cDCD), from people who die planned deaths after refusing life support, and (2) uncontrolled (uDCD), from people who have heart attacks and resuscitation fails. Particularly in the case of cDCD, the waiting time is critical since every second risks damage to organs, but we do not want to take organs before death has occurred. This raises the question of whether DCD donors are really dead. It is a more complicated question than some would think.