Between a rock and a hard place: Terminating cardiopulmonary resuscitation and preserving opportunities for organ donation

Of the more than 300,000 out-of-hospital cardiac arrests (OHCAs) that occur annually in the United States, approximately 90% result in death. Prolonged resuscitation attempts may harm patients, family members, and those performing or witnessing the resuscitation. These adverse consequences may arise after resuscitative efforts in the field or en route to or in the emergency department. However, termination of resuscitation outside the hospital forecloses opportunities for organ donation. Advances in uncontrolled donation after cardiac death (UDCD) make successful organ recovery feasible if resuscitation is continued. Hence, society has interests not only in terminating resuscitative efforts that will not restore circulation in order to minimize suffering but also in sustaining them to promote organ donation. How, then, can we decide when and where to terminate resuscitation efforts in patients with OHCA?