Donation After Brain Death vs. Donation After Cardiac Death
Donation After Brain Death (DBD)
Donation After Cardiac Death (DCD)
Injury
Severe brain injury from trauma, cerebral vascular accident,
anoxic event, other – REFERRAL TO OPO
Severe brain injury from trauma, cerebral vascular
accident, anoxic event, other - REFERRAL TO OPO
Meets Criteria
for Brain
Death
Yes –
No –
Clinical Exam (including apnea test) is consistent with Brain
Death. If unable to fully complete any part of the clinical
exam, a confirmatory test is required (ie: Nuclear Flow Scan).
some neurological reflex is still present
Prognosis
Brain death – this is the Legal Time of Death
Hospital physician determines patient has no chance of
recovery; cannot survive without mechanical ventilator.
Action
Brain death declaration is made by Hospital Physician (not
OPO).
Family/NOK elects to withdraw support
Signed brain death note and consent form are faxed to OPO.
Physician futility note, family signed WI consent and
hospital surgical consent faxed to OPO
Once BD is declared, OPO and Hospital work cooperatively
on medical management of the donor patient. Orders come
from OPO.
Patient remains on ventilator throughout organ recovery.

Anesthesiology is present for intra-operative fluid and
BP management
Donation discussion with family – they consent.
OPO/Hospital work on management of the donor pt.
Orders signed by hospital physician (no death
declaration yet, so OPO offers guidelines, but can’t sign).
Withdrawal of support can take place in OR or ICU
Transplant team spends 3-4 hours recovering organs

RT with a portable vent is used for OR w/d

ICU nurse to OR to administer meds for w/d
and assist family if they choose to come to OR
Cardiac Death

No BP, pulse, cardiac sounds or respirations
Family leaves /recovery team waits 5 minutes to ensure
no auto-resuscitation.
After 5 minutes of ceased circulation, Hospital Physician
(not OPO) declares death.
Transplant team begins rapid recovery; takes 1-2 hours
Possible Organs

Heart, lungs, liver, pancreas, kidneys, and intestine

Lungs, liver, pancreas, and kidneys
Key Points

The time of brain death is legal time of death


Brain death is not a coma, it’s irreversible – brain cells do
not recover
DCD is only discussed with families after decision to
withdraw care has been made

Rapid recovery of organs

Organs dissected in-situ


Maintained on ventilator throughout the organ recovery
If patient does not expire within 2 hours, organ
donation is no longer possible, and the patient is
returned to the unit. He/she is not re-intubated. RN
to call with CTOD to page Tissue/Eye agencies.
Make the Golden Hour Call
UW Health - Organ Procurement Organization
1-866-UWHC OPO
1-866-894-2676
Refer all deaths and imminent deaths regardless of age or
diagnosis within one hour
Clinical triggers to call :
A mechanically ventilated patient with a severe
neurologic injury or insult and one of the following:



A patient whom a physician is evaluating for brain
death
OR
A patient with a Glasgow Coma Score (GCS) of 5 or
Less
OR
A plan to discuss withdrawal of life sustaining
therapies
Timely notification is defined as referral to the OPO
within one (1) hour of patient meeting the criteria for
clinical triggers as defined above.
Time from recovery to transplantation:
Heart: 4-6 hours
Lungs: 4-6 hours
Liver: 12 hours
Pancreas: 12-18 hours
Kidneys: up to 48 hours
Small Intestines: 4-6 hours
Tissues: up to 5 years
Corneas: up to 7 days
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