Introduction: The process of organ donation is key to the process of organ transplantation as a method of treatment that aims to restore certain functions of the human body by transferring part of the donor's body into the recipient's body. Transplantation medicine is facing a global shortage of suitable organs for transplantation, and, therefore, there has been an increase in the number of organ donations after so-called circulatory death in recent years. Compared to organ harvesting after the confirmed brain death, which is the predominant method of organ donation worldwide, in the case of donation after circulatory death, organ harvesting is performed after confirmed death based on cardiopulmonary criteria, i.e. after the definitive absence of respiration and spontaneous circulation. However, in addition to professional concerns, donation after circulatory death also raises a number of ethical concerns, dilemmas and disagreements. Purpose: Through a review of the professional and scientific literature, we aim to identify donation after circulatory death as a strategy to address the global challenge of the suitable organs shortage and to gain an insight into the ethical issues of organ donation that arise in this method. The aim of this thesis is to identify and present the specific professional-ethical problems and dilemmas that accompany organ donation after circulatory death. Methods: We conducted a review of the national and international professional and scientific literature on the ethical aspects of organ donation after circulatory death, published since 2010. Literature for the thesis was searched in the Cinahl and Medline databases using the Pub Med search engine and in the DiKul web portal via remote access of the University of Ljubljana Digital Library. We searched the literature in Slovenian and English language between February 2022 and May 2022 using the following keywords: organ donation, circulatory death, ethics, DCD, transplantation, darovanje organov, cirkulatorna smrt and etika. Results: In line with the aims of the thesis, we have structured the analysis of the selected literature around three main ethical issues that accompany donation after circulatory death: confirmation of death and violation of the dead donor rule; conflicts of interest; heart transplantation after circulatory death and the use of extracorporeal membrane oxygenation after confirmed death. Discussion and conclusion: Organ donation after circulatory death comes dangerously close in some protocols to breaking the dead donor rule, which is a fundamental element of transplantation medicine. Therefore, from an ethical point of view, when introducing protocols of donation after circulatory death into practice, it is necessary to carefully consider and select only those procedures and criteria that most clearly confirm the finality of the state of death and avoid conflicts of interest. The trust and support of the professional and general public in the organ transplantation system can be quickly eroded when ethically and professionally questionable practices are carried out.
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