{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T22:20:30Z","timestamp":1784326830689,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"S4","license":[{"start":{"date-parts":[[2018,12,25]],"date-time":"2018-12-25T00:00:00Z","timestamp":1545696000000},"content-version":"vor","delay-in-days":54,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hastings Center Report"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Despite the popularity, success, and growth of programs of organ donation after the circulatory determination of death (DCDD), a long\u2010standing controversy persists over whether the organ donor is truly dead at the moment physicians declare death, usually following five minutes of circulatory and respiratory arrest. Advocates of the prevailing death determination standard claim that the donor is dead when declared because of permanent cessation of respiration and circulation. Critics of this standard argue that while the cessation of respiration and circulation may be permanent, it may not be irreversible at the moment death is declared because, if cardiopulmonary resuscitation were performed, it might succeed. And because irreversibility of cessation of respiration and circulation is required by both the statute and the biological concept of death, the donor must be alive. Who is correct?<\/jats:italic><\/jats:p><jats:p><jats:italic>Making two related distinctions clarifies the cause of the disagreement over whether the DCDD donor is dead and points to a possible resolution. First, in a determination of death, there is an important distinction between the<\/jats:italic> permanent <jats:italic>and the<\/jats:italic> irreversible <jats:italic>cessation of circulation and respiration\u2014two associated phenomena that are often confounded. Second, there is an important distinction between the medical practice standard for death determination, in which physicians certify the permanent cessation of vital functions as sufficient for death declaration, and the underlying biological concept of death that requires the irreversible cessation of vital functions because death, by definition, is an irreversible event<\/jats:italic>.<\/jats:p>","DOI":"10.1002\/hast.948","type":"journal-article","created":{"date-parts":[[2018,12,25]],"date-time":"2018-12-25T21:16:28Z","timestamp":1545772588000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Conceptual Issues in DCDD Donor Death Determination"],"prefix":"10.1002","volume":"48","author":[{"given":"James L.","family":"Bernat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,25]]},"reference":[{"key":"e_1_2_4_1_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000437178.48174.db"},{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2013.12"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-0649"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/jmp\/jhq018"},{"key":"e_1_2_4_5_1","unstructured":"Ibid."},{"key":"e_1_2_4_6_1","unstructured":"Ibid."},{"key":"e_1_2_4_7_1","unstructured":"Bernat \u201cHow the Distinction between \u2018Irreversible\u2019 and \u2018Permanent\u2019 Illuminates Circulatory\u2010Respiratory Death Determination.\u201d"},{"key":"e_1_2_4_8_1","unstructured":"Bernat \u201cOn Noncongruence between the Concept and Determination of Death.\u201d"},{"key":"e_1_2_4_9_1","unstructured":"A careful reading ofDefining Deathshows that what I call \u201cpermanent cessation\u201d of circulation and respiration was most likely the intended construal of \u201cirreversible cessation\u201d in the UDDA. This clarification was made in the Medical Consultants\u2019 Guidelines for the Determination of Death (appendix F): \u201cIn clinical situations in which death is expected and where irregular agonal respiration or heartbeat finally ceases the period of observation following the cessation may be only the few minutes required to complete the examination. Similarly if resuscitation is not undertaken and ventricular fibrillation and standstill develop in a monitored patient the required period of observation thereafter may be as short as a few minutes.\u201d The stipulated interval is far too short to prove an irreversible cessation of respiration and circulation and comports with my definition of permanent cessation (President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research Defining Death: Medical Ethical and Legal Issues in the Determination of Death[Washington D.C.: U.S. Government Printing Office 1981] 162)."},{"key":"e_1_2_4_10_1","unstructured":"Ibid."},{"key":"e_1_2_4_11_1","unstructured":"Bernat \u201cOn Noncongruence between the Concept and Determination of Death.\u201d"},{"key":"e_1_2_4_12_1","unstructured":"Ibid."},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181c58916"},{"key":"e_1_2_4_14_1","unstructured":"Ibid."},{"key":"e_1_2_4_15_1","unstructured":"Bernat \u201cOn Noncongruence between the Concept and Determination of Death.\u201d"},{"key":"e_1_2_4_16_1","unstructured":"Ibid."},{"key":"e_1_2_4_17_1","unstructured":"Ibid."}],"container-title":["Hastings Center Report"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhast.948","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hast.948","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T20:43:47Z","timestamp":1694810627000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hast.948"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":17,"journal-issue":{"issue":"S4","published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1002\/hast.948"],"URL":"https:\/\/doi.org\/10.1002\/hast.948","archive":["Portico"],"relation":{},"ISSN":["0093-0334","1552-146X"],"issn-type":[{"value":"0093-0334","type":"print"},{"value":"1552-146X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11]]},"assertion":[{"value":"2018-12-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}