Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct;51(10):1833-1854.
doi: 10.1007/s00134-025-08100-y. Epub 2025 Sep 17.

Ethical tensions and professional attitudes toward circulatory death organ donation in the ICU: a systematic review

Alessandra Agnese Grossi  1   2 , Martina Baiardo Redaelli  3   4 , Francesco Procaccio  5 , Mario Picozzi  6   4 , Giuseppe Citerio  7   8 , Luca Cabrini  3   4
Affiliations

Ethical tensions and professional attitudes toward circulatory death organ donation in the ICU: a systematic review

Alessandra Agnese Grossi et al. Intensive Care Med. 2025 Oct.

Abstract

Purpose: Donation after circulatory death (DCD) represents a valuable opportunity to expand the organ donor pool. However, its implementation in intensive care units (ICUs) remains ethically and emotionally complex. ICU healthcare professionals (HCPs) play a pivotal role in this process, yet their attitudes, knowledge, and perceived challenges are not fully understood. This systematic review aimed to explore ICU HCPs' attitudes (as defined by Rosenberg and Hovland) toward controlled DCD (cDCD).

Methods: We conducted a systematic review of studies published until March 2025 in four databases. Eligible studies included original research reporting ICU-specific data on HCPs' attitudes toward DCD. Study quality was assessed using the Mixed Methods Appraisal Tool. A structured narrative synthesis was performed.

Results: Twenty-five studies involving 3,878 HCPs were included. Overall, support for DCD was evident though it remained lower than for donation after brain death. Ethical concerns focused on potential conflicts of interest between the withdrawal of life-sustaining treatment and the pursuit of organ donation, the timing of withdrawal, the urgency of organ retrieval, and the challenge of balancing compassionate end-of-life care with procedural imperatives. Common barriers included the lack of standardized protocols, insufficient training, and uncertainty surrounding death determination.

Conclusions: While ICU HCPs generally support DCD, significant ethical tensions and systemic barriers persist. Institutional efforts should focus on implementing clear protocols, promoting interprofessional education, and providing emotional support to ensure ethical integrity and staff well-being. Future research should explore differences in attitudes between uDCD and cDCD and work toward the development of validated tools to assess professional attitudes.

Keywords: Donation after circulatory death; Ethical challenges; Healthcare professionals; Intensive care unit; Moral distress; Organ donation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors have no conflicts of interest to disclose as described by Intensive Care Medicine.

References

    1. Abouna GM (2008) Organ shortage crisis: problems and possible solutions. Transplant Proc 40:34–38. https://doi.org/10.1016/J.TRANSPROCEED.2007.11.067 - DOI - PubMed
    1. Citerio G, Cypel M, Dobb GJ et al (2016) Organ donation in adults: a critical care perspective. Intensive Care Med 42:305–315. https://doi.org/10.1007/S00134-015-4191-5 - DOI - PubMed
    1. EDQM Council of Europe (2024) Transplant newsletter: international figures on donation and transplantation. Available at: https://graphics.tts.org/newsletter-transplant-OCT2024.pdf [Date last Accessed 28 July 2025]
    1. Heeley B, Hodierne L, Johnson I, Gardiner D (2023) A single-center exploration of attitudes to deceased organ donation over time among healthcare staff in intensive care. Transplant Direct 9:E1557. https://doi.org/10.1097/TXD.0000000000001557 - DOI - PubMed - PMC
    1. Savier E, Lim C, Rayar M et al (2020) Favorable outcomes of liver transplantation from controlled circulatory death donors using normothermic regional perfusion compared to brain death donors. Transplantation 104:1943–1951. https://doi.org/10.1097/TP.0000000000003372 - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources