Editorial comment: donation after circulatory death: an important expansion of donor organs for lung transplant patients.

Just as a follow-up, you have been able to increase your percentage of DCD donors as a part of your donor pool to approximately 25%. Where do you see this going in the next three to five years in your own group as you consider expanding on your experience? What per cent do you think are actually going to become DCD rather than DBD donors? Dr Zych: Looking at our progress, we started from around 10–12% increasing to our most recent percentage of 25%. What the dynamics of the process will be, I cannot predict. But as we know from one of the most recent publications from the Groningen group, almost 40–50% of their donations are DCD. Looking at the results, which are good, I think that the trend will be towards a higher percentage. Dr L. Hamilton (Newcastle-upon-Tyne, UK): We too have an active DCD program, and I thank you for your very important clinical message that these lungs are just as good as DBD donors. But I would like to raise an ethical rather than a clinical question with you. The definition of 'death' continues to be controversial. In fact, the President's group in the States recently produced a 167-page document dealing with the controversies, and that is 40 years after the Harvard group first defined brain death. In your presentation, you referred to DCD as donation after cardiac death and, in fact, there have been some reports in the literature of heart transplants from DCD donors, so clearly the heart is not dead. Do you think the public have concerns about DCD donation, and what can we do as professionals to allay those concerns? Dr Zych: I am not an expert in ethics, and whatever I say is just what I think. As we know, there is the very difficult process of discussing all the issues about the donation with the family. Everything is discussed with the family; it is carried out in accordance with the law. The donor after cardiac death is a donor who has been certified dead. If somebody expressed the wish, the family or the patient who is in an organ donor registry, that he might be an organ donor after death, I think that we are correct. Of course, I cannot tell you I am right because it is a very sensitive, delicate matter. As we know, donation after cardiac death is …