Variability in the Determination of Death After Cardiac Arrest: A Review of Guidelines and Statements Sonny Dhanani, MD, FRCPC 1,3 , Laura Hornby, MSc 2,3 , Roxanne Ward, RN, BA (Psy) 3,4 , and Sam Shemie, MD, FRCPC 5,6 Abstract Introduction: The reemergence of organ donation after circulatory determination of death (DCDD) in Canada demands the establishment of clear, evidence-based guidelines for the determination of death. The primary purpose of this study was to inves- tigate the variability in specific criteria, diagnostic tests, and recommended wait periods for the determination of death after car- diac arrest. Methods: We used PubMed and Web of Science to perform a structured search of the medical literature for articles published up to January 1, 2010. We also performed an unstructured search of the internet for unrestricted, readily available, nonjournal sources. We limited the search to countries that are most active in DCDD. Results: A total of 26 documents were retrieved; 21 medical professional society/institution statements and 5 national/international guidelines. Specific criteria for the determination of death after cardiac arrest were cited in 24 documents: 14 recommend cardiocirculatory criteria alone; 6 oblige the requirement of a prolonged waiting period after declaration to ensure neurological death; 3 recommend following ‘‘accepted medical practice’’ without specific details; and 1 leaves the definition up to ‘‘national authorities.’’ Only 16 of the documents require specific diagnostic procedures with unresponsiveness, absent arterial pulse and apnea cited the most consistently. Specific wait periods after declaration are required for the determination of death after cardiac arrest in 24 documents, cited times range from 2 to 10 minutes, with a 5-minute period the most frequent. Conclusions: This review is the first to document the variability of guidelines and statements for the determination of death after cardiac arrest, in countries where the practice of DCDD is becoming increasingly common. The scarcity of peer-reviewed published guidelines in the medical literature exemplifies the need for further investigation. We believe these results will inform the ethical discussions surrounding the determination of death after cardiac arrest. Clear and consistent guidelines based on evidence are needed to fulfill medical, ethical, and legal obligation and to ensure public trust. Keywords death determination, cardiac arrest, organ donation, guidelines Received May 21, 2010, and in revised form July 12, 2010. Accepted for publication August 12, 2010. Introduction One of the responses to the persistent and mounting supply-demand discrepancy for organ transplants has been the reemergence of the practice of organ donation after circulatory determination of death (DCDD)—also known as donation after cardiac death or nonheart-beating organ donation. Unlike cases of organ procurement following neurological determination of death, organs from DCDD donors are acquired after an informed decision is made that the patient is most likely to die after withdrawal of life-sustaining therapies. The medical staff then must wait to determine death prior to organ removal. The potential for abuse stems from the fact that organs are optimally removed within minutes after the determination of death in order to minimize organ ischemic times and ensure successful transplantation. Considering that the fundamental principle that 1 Pediatric Critical Care, Children’s Hospital of Eastern Ontario, Faculty of Medicine, University of Ottawa, Canada 2 McGill University Health Centre Research Institute, Montreal Children’s Hospital, Montreal Quebec 3 Bertram Loeb Research Consortium in Organ and Tissue Donation, University of Ottawa, Canada 4 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, Canada 5 Division of Critical Care, Montreal Children’s Hospital, McGill University, Montreal Quebec, Canada 6 Bertram Loeb Chair in Organ and Tissue Donation, University of Ottawa, Canada Corresponding Author: Sonny Dhanani, Pediatric Critical Care, Children’s Hospital of Eastern Ontario, Assistant Professor, Faculty of Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1 Email: sdhanani@cheo.on.ca Journal of Intensive Care Medicine 27(4) 238-252 ª The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0885066610396993 http://jicm.sagepub.com