When End-of-Life Becomes the Beginning of New Life: Application of the Society of Critical Care Medicine Clinical Practice Guidelines on Adult End-of-Life Care in the ICU to the Setting of Donation After Circulatory Death.

The recently published Society of Critical Care Medicine Guidelines on Adult End-of-Life Care in the ICU provide a detailed and well-thought-out approach to a vital component of critical care, although they explicitly refrain from discussing how they may apply to organ donation. As representatives of the Donor Care Unit Network for Optimizing Recovery (DONOR), a group of intensivists experienced in managing donation after circulatory death (DCD), we wish to endorse equal delivery of high-quality end-of-life (EOL) care for organ donors. Although some logistical differences must be addressed, the EOL recommendations outlined in the Guidelines are still applicable to patients being evaluated for or undergoing DCD. Recent accounts of unacceptable patient care in the setting of DCD highlight a critical threat to patient welfare and public trust. Our mandate is clear: implement and audit protocols that guarantee dignity and symptom control while demonstrating that DCD remains wholly consistent with a compassionate, honorable, and fulfilling EOL.