Contribution of the ethics committee of the French society of intensive care medicine to a scenario for the implementation of organ donation after Maastricht III-type cardiac death in France

Ann Fr Anesth Reanim. 2014 Feb;33(2):128-34. doi: 10.1016/j.annfar.2014.01.003. Epub 2014 Jan 23.


French law allows organ donation after death due to cardiocirculatory arrest. In the Maastricht classification, type III non-heart-beating donors are those who experience cardiocirculatory arrest after the withdrawal of life-sustaining treatments. French authorities in charge of regulating organ donation (Agence de la Biomédecine, ABM) are considering organ collection from Maastricht type III donors. We describe a scenario for Maastricht type III organ donation that fully complies with the ethical norms governing care to dying patients. That organ donation may occur after death should have no impact on the care given to the patient and family. The dead-donor rule must be followed scrupulously: the organ retrieval procedure must neither cause nor hasten death. The decision to withdraw life-sustaining treatments, withdrawal modalities, and care provided to the patient and family must adhere strictly to the requirements set forth in patient-rights legislation (the 2005 Léonetti law in France) and should not be influenced in any way by the possibility of organ donation. A major ethical issue regarding the family is how best to transition from discussing treatment-withdrawal decisions to discussing possible organ retrieval for donation should the patient die rapidly after treatment withdrawal. Close cooperation between the healthcare team and the organ retrieval team is crucial to minimize the distress of family members during this transition. Modalities for implementing Maastricht type III organ donation are discussed here, including the best location for withdrawing life-sustaining treatments (operating room or intensive care unit).

Keywords: Cardiocirculatory arrest; Organ donation; Treatment withdrawal.

MeSH terms

  • Airway Extubation
  • Attitude to Health
  • Brain Death
  • Conflict of Interest
  • Critical Care*
  • Death
  • Dissent and Disputes
  • Ethics Committees*
  • France
  • Heart Arrest*
  • Humans
  • Patient Care Team
  • Professional-Family Relations
  • Prognosis
  • Societies, Medical*
  • Terminal Care / ethics*
  • Terminal Care / legislation & jurisprudence
  • Terminal Care / standards
  • Third-Party Consent
  • Tissue Donors / classification*
  • Tissue and Organ Harvesting / legislation & jurisprudence
  • Tissue and Organ Harvesting / methods
  • Tissue and Organ Harvesting / standards
  • Tissue and Organ Procurement / ethics*
  • Tissue and Organ Procurement / legislation & jurisprudence
  • Tissue and Organ Procurement / standards
  • Withholding Treatment / legislation & jurisprudence