Pathways to Donation

In most cases, organ donation can only occur when a patient suffers from brain death.  Tissue donation is an option for patients that suffer from cardiac death or brain death.

Brain Death

  • Patient maintained on ventilator, heart beating
  • Candidate for organ and tissue donation
  • Tissue recovery follows organ donation

 

The Donation Process after brain death:

  1. Patient meets clinical triggers for donation. (Patient has been ventilated, suffered a devastating illness or injury, and lost one or more brainstem reflexes—i.e., pupils fixed, no cough, no gag, no response to painful stimuli, no spontaneous respirations.)
  2. Hospital staff calls Center for Donation and Transplant at 1-800-803-6667 before any family discussion of DNR, comfort care, or withdrawal of ventilator.
  3. A CDT organ procurement coordinator determines medical suitability for donation.
  4. If patient is determined to be a suitable candidate for donation, the physician discusses evidence of brain death with the family.
  5. The CDT organ procurement coordinator and family services team works with the patient care team on a plan for talking to the family about donation.
  6. The CDT team facilitates the donation conversation with the family.
  7. If the patient is Donor Designated (i.e., registered as an organ donor), this serves as authorization and the family is provided with full disclosure. If the patient is not Donor Designated, authorization is obtained.
  8. Patient is maintained on a ventilator in the ICU for donor management and organ allocation.
  9. Family is provided with the time needed to say their final words, and are offered the opportunity to partake in a moment of silence and reflection in honor of their loved one.
  10. Patient is transferred to the OR for organ recovery. Family Services team remains available to offer the necessary support and resources to the family, as needed.

Cardiac Death

  • Patient has no cardiac or respiratory activity
  • Candidate for tissue donation only
  • Body must be kept cool before tissues are recovered
  • Recovery is within 24 hours of death

 

Donation After Cardiac Death

In some instances, a health care team may determine that, while a patient may not progress to brain death, death may be imminent. Donation after Cardiac Death (DCD), while rare, preserves the option of donation for donors and their families.

In DCD:

  • Donation after planned withdrawal of care and cardiac death
  • Patient may have neurological function, but is likely to expire within 60 minutes of withdrawal, based on healthcare team assessment
  • Circulation is not present at time of organ recovery

 

The Donation Process (DCD):

  1. Patient meets clinical triggers for donation. (Patient has been ventilated, suffered a devastating illness or injury, and lost one or more brainstem reflexes—i.e., pupils fixed, no cough, no gag, no response to painful stimuli, no spontaneous respirations.)
  2. Hospital staff calls CDT at 1-800-803-6667 before any family discussion of DNR, comfort care, or withdrawal of ventilator.
  3. A CDT organ procurement coordinator begins donor assessment.
  4. If a neurological exam is not consistent with brain death, physician and family have discussion about withdrawal of life support as an appropriate option.
  5. If patient is determined to be a suitable candidate for donation, the CDT coordinator and family services team works with the patient care team on a plan for talking to the family about donation.
  6. The CDT team helps facilitate the donation conversation with the family.
  7. Patient is maintained during further evaluation as a potential donor after circulatory death. CDT will collect patient medical information.
  8. The patient is transported to the location of withdrawal (preferably the OR).
  9. Family is provided with the time needed to say their final words, and are offered the opportunity to partake in a moment of silence and reflection in honor of their loved one. CDT staff are present to support and assist the family in any way necessary.
  10. Hospital staff facilitates preparation for withdrawal of support per hospital policy.
  11. Support is withdrawn. Declaring hospital physician must be present to pronounce death.
  12. Patient declared dead by cardiopulmonary criteria by non-transplant-related MD (according to hospital policy). After a five-minute observation period, organ recovery begins.
  13. Family Services team remains available to offer the necessary support and resources to the family, as needed.

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