POSITION PAPER
Transpl. Int.
cDCDD and Heart Procurement: Challenges from a French Critical Care Perspective
- ML
Matthieu LE DORZE 1,2
- JC
Julien CHARPENTIER 3
- GC
Gaëlle CHEISSON 4
- DC
David Couret 5
- GD
Guillaume Ducos 6
- BZ
Benjamin Zuber 7
1. Department of Anesthesiology and Critical Care, Hopital Lariboisiere, FHU PROMICE, DMU Parabol, AP-HP. Nord, Assistance Publique Hopitaux De Paris, Paris, France
2. INSERM U942 Biomarqueurs Cardioneurovasculaires, Paris, France, Île-de-France, 75475
3. Medical Intensive Care Unit, AP-HP Centre Université Paris Cité, Cochin hospital, Assistance Publique Hopitaux De Paris, Paris, France, Île-de-France, 75004
4. Department of Anaesthesia and Intensive Care Medicine, Hôpital Bicêtre, AP-HP, Assistance Publique Hopitaux De Paris, Paris, France, Île-de-France, 75004
5. Neurocritical Care Unit, University Hospital Saint Pierre, Institut National de La Santé Et de La Recherche Médicale, Diabète Athérothrombose Réunion Océan Indien, Université de la Réunion, Saint-Denis, France, 97744
6. Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France, Occitanie, 31059
7. Intensive Care Unit, Hôpital Foch, Suresnes, France, 92150
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Abstract
Controlled donation after the circulatory determination of death (cDCDD) is currently one of the most promising ways to increase organ availability. In France, a national cDCDD protocol requiring abdominal normothermic regional perfusion (A-NRP) has been in place since 2015. The recent consideration of heart procurement from cDCDD donors has reignited clinical and ethical debates within the critical care community. This position paper, endorsed by the two French intensive care societies, provides a critical care perspective on this evolving practice. Two key challenges are identified. First, heart procurement may require the withdrawal of life-sustaining measures (WLSM) to occur in or near the operating room, in contrast with French practice where WLSM mostly takes place in the ICU. Intensivists strongly advocate maintaining ICU-based WLSM whenever possible, and ensuring continuity of care and end-of-life support when relocation is unavoidable. Second, the use of NRP raises concerns about the permanence of death and compliance with the dead donor rule. These concerns can be addressed through targeted biomedical research and a robust ethical framework affirming that death is declared prior to NRP and that no return to life is possible thereafter. Transparent engagement with these challenges is essential to sustain trust in the cDCDD pathway.
Summary
Keywords
controlled donation after circulatory death, end-of-life care, normothermic regional perfusion, dead donor rule, heart procurement
Received
17 April 2025
Accepted
29 September 2025
Copyright
© 2025 LE DORZE, CHARPENTIER, CHEISSON, Couret, Ducos and Zuber. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Matthieu LE DORZE, matthieu.ledorze@aphp.fr
Disclaimer
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