Problematising the ethics of organ donation after circulatory death in the UK

This commentary addresses the ethics of controlled organ donation after circulatory death (DCD) in the UK, a practice which has recently been revived as part of attempts to increase rates of organ donation. Despite being linked to growth in donor rates, bioethics and clinical scholars have drawn attention to the ethical issues which DCD poses for health professionals, particularly around the requirement to alter the end-of-life care of potential donors. In this commentary, the UK policy response to the ethics of DCD is examined by drawing on Foucault's problematisation approach. This analyses the broader contexts within which the policy version of ethics for DCD has been created, and examines the potential implications of this form of ethics for the work of health professionals. It is argued that the policy version of ethics for DCD has a specific normalising role, which acts as an integral part of the efficiency drive by transplant medicine to optimise the potential for donation. In turn, this form of ethics is premised upon providing the right tools for health professionals to make ethical decisions around DCD. In so doing, it fails to account for the everyday practices of health professionals involved in end-of-life care. In conclusion, the commentary advocates bringing the social science perspective into debates on DCD, to ensure that the terms and practice of this technology, and its policies, are adequately problematised.