The Bucharest International (ESOT) consensus on Controlled Donation with Circulatory Determination of Death (cDCDD)

Controlled donation after circulatory determination of death (cDCDD) is now a major contributor to transplant activity worldwide, yet its expansion has been complicated by inconsistent terminology, diverse clinical protocols, and ethical uncertainties.

To address these challenges, the European Society for Organ Transplantation convened a global consensus forum in Bucharest involving multidisciplinary experts from various geographic regions. Four steering committees were established to address adult and paediatric donation pathways, normothermic regional perfusion, and the determination of death. Using a structured methodology, expert panels participated in two waves of surveys complemented by an in-person meeting to develop recommendations on key clinical and ethical aspects of cDCDD. This collection presents the conclusions of the consensus meeting, separated in 5 chapters addressing methodology, definition of death, standards, normothermic regional perfusion (NRP) and pediatric aspects.

Keywords: cDCDD, donation after circulatory death, normothermic regional perfusion, organ transplantation, determination of death, paediatric donation, clinical consensus, transplant ethics, organ procurement, ESOT, Delphi method, end-of-life care, clinical guidelines, bioethics