In most cases of cardiac death, the organs are not viable for transplantation but the patient may be a candidate for tissue donation. However, organ donation after cardiac death (DCD) may be an option for patients that have suffered severe brain damage and have no chance for survival, but will not progress to brain death due to the retention of minor brain stem function.

Potential DCD Donors

In potential DCD cases, a patient has suffered a severe brain injury and the healthcare team has determined that he or she will not survive. The patient’s family is informed of the prognosis and counseled on all of their options. The decision to withdraw life support is made by the family and healthcare team, which may include the patient’s physician, nurses, clergy and social worker.

After the decision to withdraw support has been made, the Center for Donation & Transplant is contacted regarding the suitability of the patient for organ donation. All imminent death referrals to CDT must be made prior to extubation. Timely referral of potential DCD donors is necessary to ensure that families are offered the option of donation in a sensitive and appropriate manner. CDT’s 24 hour referral number is1-800-803-6667.

If the patient meets the medical criteria to be a candidate for DCD, the family is approached by an organ procurement coordinator to discuss the option of donation. Donation is only considered AFTER the family has made the decision to extubate. The family will not be offered the option to donate until they have independently decided to withdraw life support.

The Recovery Process

If the patient has documented his/her wishes to donate or the family consents, the patient is transferred to an operating room and removed from the ventilator. The transplant team will not be present in the operating room during extubation and declaration of death. When the heart stops beating, a hospital physician declares death. After an additional five minutes of waiting to ensure the heart does not start beating, the transplant team enters the operating room and organ recovery proceeds. If expiration does not occur within one hour of extubation, the patient will be moved to palliative care or a designated floor.

Joint Commission Standards

JCAHO Standards

The Joint Commission on the Accreditation of Health Care Organizations (JCAHO) will be including language in their 2007 standards that requires hospitals to have DCD protocol in place. CDT coordinators are working with their assigned hospitals to implement or update DCD protocols. For further information, please call (518) 262-5606.

Donor Family Aftercare

Donation after cardiac death gives more families the potential to donate, allowing them an opportunity to honor their loved one’s final wishes and offering them some hope in the wake of their loss. Families are given as much time as they need with the patient, and the family’s needs are always the top priority for both CDT and hospital staff. All of CDT’s donor families are invited to participate in CDT’s aftercare program, which provides families with grief support activities and events.