Source:Mandell MS, Zamudio S, Seem D, et al. National evaluation of healthcare provider attitudes toward organ donation after cardiac death.
Crit Care Med.
–2958; doi:10.1097/01.CCM.0000247718.27324.65

The Organ Procurement and Transplantation Network has launched multiple initiatives to increase the number of transplantable organs. One strategy is to encourage the recovery of organs from patients declared dead using cardiopulmonary criteria – donation after cardiac death (DCD). The authors convened 17 semi-structured focus groups to determine attitudes and beliefs regarding organ donation after cardiac death from providers likely to be involved in the organ donation process. The following types of providers were identified from national medical organizations: transplant surgeons, neurosurgeons, neurologists, perioperative nurses, neuroscience nurses, critical care nurses, organ procurement organizations, and medical examiners. There were 141 participants in the 17 groups.

The themes identified regarding DCD included its potential to increase the organ supply, questions about the quality of donor organs, lack of standards for care for potential DCD donors, and the potential for abuse in order to obtain organs. The authors concluded that ethical concerns regarding DCD make some health care providers reluctant to accept and support the practice. Participants voiced a need for “uniform national guidelines” on DCD to help with prognostication and definition of death, and the need to avoid potential conflict of interest. Use of a neutral third party to initiate the potential donation process after a decision has been made to withdraw care may improve acceptance. The authors also point to a 46% increase in DCD from 2004 to 2005, and suggest that many centers have already standardized end-of-life care to include discussions regarding DCD.1 

Dr. Bratton has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

DCD was the only method for donation after death prior to the acceptance of brain death criteria in 1968.2 Inadequate organ preservation techniques and the advent of brain death guidelines almost eliminated the use of organs from donors after cardiac death. However, the increasing organ shortage, improved preservation techniques, and the need to support families who desire the option of donation has prompted reinvestigation of this process. The Society of Critical Care Medicine,3 the Institute of Medicine (IOM),4 the Joint Commission on Accreditation for Health Care Organizations,5 and the American Medical Association6 have all evaluated and support DCD.

DCD can be offered to families if a patient is likely to die quickly after support is withdrawn, typically within an hour. After a family has come to terms with the consequences of their child’s injury or illness and has elected to withdraw support, they can then be offered information on DCD. It is important that this opportunity be presented only after the family has made a decision to withdraw support. To avoid the appearance of a conflict of interest, many physicians opt not to...

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