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Resuscitation policy should focus on the patient, not the decision

BMJ 2017; 356 doi: (Published 28 February 2017) Cite this as: BMJ 2017;356:j813

Organ donors may need CPR after death despite a DNACPR decision

This insightful article omits one important point: there are some circumstances in which even those patients who had recorded a DNACPR decision should receive CPR. This is when (and only when) the patient wanted to donate his or her organs and is already brain dead, but cardiac arrest occurs. In such cases, organ-preserving CPR (OP-CPR) can be used to restart the heart in order to keep organs perfused until transplantation.[1] While this use of CPR is rare, it is important to bear in mind that DNACPR decisions do not necessarily extend to refusal of CPR in order to preserve organs for transplantation. Indeed, refusing to engage in OP-CPR because of a previous DNACPR decision when the patient had a strong wish to donate would be problematic.

1. Dalle Ave AL, Gardiner D, Shaw DM. Cardio-pulmonary resuscitation of brain-dead organ donors: a literature review and suggestions for practice. Transpl Int. 2016 Jan;29(1):12-9

Competing interests: No competing interests

20 March 2017
Bernice Elger
Senior researcher
University of Basel
Bernoullistrasse 28