Circulatory arrest in a brain-dead organ donor: is the use of cardiac compression permissible?

Care of the brain-dead patient is common in intensive care practice. Aggressive donor management is advocated to increase supply of viable organs. Significant controversy exists over cardiac resuscitation in patients determined dead by cardiac criteria. The issue, till now, has not been addressed in brain dead patients. We discuss a case of cardiac resuscitation of a brain-dead donor to ensure organ donation. This case allows us to examine the use of brain death criteria to declare death, the controversy regarding cardiac resuscitation in organ donor patients, and the standards for use of cardiac resuscitation in the organ donor declared dead by brain death criteria. The consent process for organ donation in brain dead patients should address the possibility of subsequent cardiac arrest.