[Controlled Donation after Circulatory determination of Death (cDCD) : A position paper by the DCD working group of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI)].

In Germany at present, patients with a deleterious brain damage must be denied their wish for organ donation if the full clinical picture of "brain death" (DNC) does not occur. This significantly limits the individual patient's autonomy at the end of life. Intensive care may and must be withdrawn if the patient refuses its continuation. Following withdrawal of life-sustaining measures (WLST), the patient then dies - whilst receiving palliative care - as a result of cardiocirculatory arrest. In many countries, a patient's death following cardiocirculatory arrest may - under strictly regulated conditions - be followed by organ donation (controlled Donation after Circulatory determination of Death, cDCD): Cardiocirculatory arrest occurs after WLST under intensive care monitoring. After a "no-touch"- period of five minutes, spontaneous resumption of cardiac activity is no longer to be expected. The collapse of the entire circulatory system results in a complete cessation of cerebral blood flow and, consequently, the rapid onset of the global loss of brain function. In accordance with the patient's wishes, cardiopulmonary resuscitation is not performed, thus leading to a permanent loss of brain function. Clinical examination of brainstem reflexes once the no-touch period has elapsed confirms this permanent loss of cerebral function and the patient is declared dead. Organ donation may follow if desired by the patient. The transplant outcomes for organs donated following cDCD are on a par with those from DBD donation. cDCD respects and fulfils the wish to donate organs expressed by many intensive care patients. A foreseeable increase in organ donations will have a significant impact on the lives of patients on the transplant waiting lists.