[Ethical concerns around donors after cessation of active treatment].

The cessation of treatment in intensive care leads to death through circulatory arrest. In these circumstances there is an opportunity to remove organs, if that was the wish of the patient. This raises legitimate ethical questions. A French national protocol defines the conditions of this donation and ensures a harmonisation of practices as well as an overall improvement in end-of-life support in intensive care. These donors represent an opportunity to increase the number of organs available for transplant.

Dorez D 《-》

How France launched its donation after cardiac death program.

On the basis of the literature and results presented at the 6th International Conference, donation after cardio-circulatory death provides a significant, practical, additional high quality source of transplantable organs. The vast majority of DCD are 'controlled' Maastricht category III donors. In 2010, the parliamentary information mission on the revision of the bioethics laws invited the Intensive Care Societies to debate and to make recommendations to implement controlled donation after circulatory death. They came to the conclusion that such retrieval is possible in France and insisted on the medical criteria that frame it: the writing of the medical procedures, the ethical aspects and the delay. The major recommendations of the ethics committees were firstly, The WLST decision is independent of the possibility of organ donation; secondly, the strict respect of "The dead donor and organ transplantation rule" and the updated national guidance for the WLST; thirdly, the drafting of a nationally agreed protocol defining the mandatory conditions to determine death and to perform procurement and transplantation. Organ donation after WLST will be authorised only in pilot centres with a locally agreed WLST policy including external second opinion and written transcript of the WLST decision, experienced intensive care staff, a local organ procurement coordination team familiar with DBD and DCD protocols and only in hospitals authorised for organ procurement. It is important to have an optimal and standardized national guidance to limit the known risk factors of graft failure (donor and recipient choice, warm and cold ischemia time), to increase acceptance by medical community and civil society and to improve results and allow more powerful analysis.

Antoine C ，Mourey F ，Prada-Bordenave E ，Steering committee on DCD program ... -  《-》

[Organ and tissue donation after cessation of treatment in intensive care, the role of the nurse coordinator].

Since the end of 2014 in France, it has been possible to remove organs after a process of cessation of active treatment. This new procedure requires rigorous and well-managed organisation, as well as close collaboration between all those involved in the care, notably in the coordination of organ and tissue procurement.

Cailleton A ，Lecomte E 《-》

[The coordination of organ and tissue donation after circulatory arrest].

A practice authorised in France for some years, organ and tissue donation from a circulatory death donor must follow a specific medical process. It is an extreme emergency to be managed within a few minutes, and in which the organ donation nurse coordinator plays a key role in the hospital.

Roussin F 《-》

[New conditions for organ donation in France].

The procurement of organs from donors after circulatory death is a reliable technique which gives satisfactory posttransplant results and also represents a potential source of additional organs. In order to meet the growing need for organ donations, the 'anticipated organ donation approach' procedure is currently receiving renewed interest with new conditions for its implementation in France.

Antoine C ，Maroudy D 《-》