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Donation After Cardiac Death

Learn about Donation After Cardiac Death (DCD), its process, history, and importance in organ donation. Discover how DCD can positively impact the shortage of transplantable organs and the ethical principles surrounding the practice.

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Donation After Cardiac Death

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  1. Donation After Cardiac Death May 26, 2010 Margie Whittaker, RN MSN

  2. Anne’s Story • RN colleague collapsed while at work • SAH with extensive bleeding • Poor prognosis • Family wishes to donate organs to honor Anne • Did not progress to brain death • After 48 hours of waiting, withdrawal of life support occurred and Anne died within about 30 minutes

  3. Fundamentally… The family / patient should make the decision to withdraw life support • independent of and • prior to ANY discussion regarding organ donation.

  4. History and Facts • History of DCD: • Prior to Brain Death Laws – common practice: Kidney 1951 Liver 1961 Pancreas 1966 Heart 1967

  5. DCD over the years

  6. Why DCD? • > 100,000 people on the waiting list • 17-20 people die every day • DCD Organ recovery can positively impact the shortage of transplantable organs

  7. Introduction • Organ donation can occur after brain death or after cardiac death DCD – potentials: • The patient has a non-recoverable illness or injury and has suffered neurological devastation. • Family / Patient is considering withdrawing life-sustaining treatment

  8. Process • Family and medical staff begin discussions of withdrawal of life sustaining treatment. • Refer the patient to OneLegacy. • OneLegacy will evaluate pt for medical suitability – at this time NO APPROACH will be made.

  9. Assessment • OneLegacy and health care team determine cardio-respiratory death likely to occur within one hour of withdrawal of life support • Huddle – to Care - Plan

  10. Decision • Decision is made by the family to withdraw life-sustaining treatment • OneLegacy will consult coroner or medical examiner for release

  11. Consent Process • Effective requestor approaches • Family declines donation – continue with end-of-life care process • Family consents to donation – continued medical management of patient

  12. Pre-OR • Continued supportive care for patient • Attending MD/critical care nursing continues to manage the pt • OneLegacy provides recommended parameters for donor management and lab studies

  13. Pre-OR (cont.) • OneLegacy will utilize usual process for the organ allocation. • OneLegacy will collaborate/coordinate with the OR and transplant team for a timing of recovery. • OneLegacy will huddle with hospital staff to care-plan for the OR

  14. Intra-OR Process • After transfer to the OR • Withdrawal of life-sustaining treatment is performed in the OR • Driven and directed by the hospital under their policy

  15. Pronouncement of Death • The patient will be pronounced dead after 5 minutes of no blood pressure and: • asystole or • ventricular fibrillation or • pulseless electrical activity • The practitioner certifying death may not be involved in the recovery or transplantation of the organs

  16. Pronouncement of Death • The practitioner will record the date and time of death in the medical record and, if applicable, complete the death certificate.

  17. Alternative Outcome • Patient does not arrest within organ-viability time-frame – donation is no longer an option • Continue with end-of-life care in a nursing unit • OneLegacy responsible for the costs: • From time of consent – until – organ donation completed or donation process aborted

  18. Ethical Principles • Ethical principles around organ donation continue to be discussed and studied • Primary discussion is around “dead donor rule” • Allowing patients to die for organ gains • Use of ECMO after cardiac/respiratory cessation • Honoring wishes and rights of first person consent for SCI or ALS patients • Analgesia at time of withdrawal

  19. Outcome of Process Policy has been in place since 2001 • 10 DCD donations since that date (about 1-2 year) • Potential DCD donors increased every year • 15 lives saved!! • Family able to honor patient’s wishes

  20. Conclusions Donation after Cardiac Death is a viable option to honor patient’s wishes. It should be considered in excellent end of life care for any patient who has sustained a catastrophic neuro event. Margie.whittaker@stjoe.org

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