Donation After
Cardiac Death
May 26, 2010
Margie Whittaker, RN MSN
Anne’s Story
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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
Fundamentally…
The family / patient should make the
decision to withdraw life support
– independent of and
– prior to
ANY discussion regarding organ donation.
History and Facts

History of DCD:
– Prior to Brain Death Laws – common practice:
Kidney
Liver
Pancreas
Heart
1951
1961
1966
1967
DCD over the years
1000
900
800
700
600
500
400
300
200
100
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
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
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
Process
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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.
Assessment

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OneLegacy and health care team
determine cardio-respiratory death
likely to occur within one hour of
withdrawal of life support
Huddle – to Care - Plan
Decision

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Decision is made by the family to
withdraw life-sustaining treatment
OneLegacy will consult coroner or
medical examiner for release
Consent Process
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Effective requestor approaches
– Family declines donation – continue with
end-of-life care process
– Family consents to donation – continued
medical management of patient
Pre-OR
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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
Pre-OR (cont.)
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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
Intra-OR Process
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After transfer to the OR
Withdrawal of life-sustaining treatment is
performed in the OR
Driven and directed by the hospital under
their policy
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
Pronouncement of Death

The practitioner will record the date
and time of death in the medical
record and, if applicable, complete the
death certificate.
Alternative Outcome
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Patient does not arrest within organviability 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
Ethical Principles
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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
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
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