Organ Donation After Cardiac Death

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Organ Donation After Cardiac Death Powered By Docstoc
					 Organ Donation
   Saving more liveS
AfterCardiac Death
Organ donation offers comfort to grieving families and hope to patients
in need. Over the past 30 years, organ transplantation evolved from an
experimental procedure to the treatment of choice for patients suffering
from end-stage organ failure. The dramatic improvement in quality of
life after transplantation has significantly increased the demand for solid
organ transplants. Thousands of patients wait for a transplant because of
the organ shortage. The numbers tell the story.

 Close to 90,000 people wait for an organ transplant in the U.S.

 Seventeen individuals die each day awaiting an organ transplant.

 An individual is added to the waiting list every 15 minutes.

 Only one in five will receive a transplant each year.

 Nearly 6,000 men, women and children die each year waiting
  for a transplant.
Donation After Cardiac Death…
And Some Organ Donation History

Only a small percentage of hospital deaths are brain deaths. Reliance on
donation after brain death severely limits organ availability.

Formerly called Non-Heart-Beating Donation (NHBD), Donation After
Cardiac Death (DCD) has been an end-of-life option for patients and
                                                                             DC D — A Short Description
families for more that 30 years. Prior to the introduction of brain death
                                                                             DCD is an option for families of patients with severe brain
laws, DCD was the way in which all organs were recovered.
                                                                             injuries, who do not meet the criteria for brain death. After
Early on, DCD had limitations, such as poor organ function for recipients.   the decision has been made that the patient has no chance of
Initially, only kidneys could be recovered from DCD donors. Donation         survival and the family has decided to withdraw treatment, the
after brain death offered better outcomes and the ability to recover and
                                                                             family is offered the option of Donation After Cardiac Death. If
transplant the heart, lungs, liver, pancreas, kidneys and intestines. As a
                                                                             the family agrees, the patient is moved to an operating room
result, donation after brain death became the preferred method of organ
                                                                             where support is withdrawn. In some situations, support may
recovery and nearly all organ procurement organizations (OPOs) stopped
                                                                             be withdrawn in the intensive care unit/ICU. Once the patient’s
pursuing DCD donors.
                                                                             heart stops beating, the physician declares death. Following
However, the shortage of organs available for transplantation created        an additional five minutes of waiting to ensure the heart does
renewed interest in DCD. Improved medications and surgical techniques
                                                                             not start beating again, organ recovery begins. The organs are
dramatically improved the outcomes of transplants from DCD donors.
                                                                             then recovered.
All these advocates–coupled with the increasing organ shortage–make
Donation After Cardiac Death an option for patients and families
interested in organ donation.
Donation After Brain Death vs. Donation
After Cardiac Death
               Donation After                             Donation After
               Brain Death (DBD)                          Cardiac Death (DCD)

Injury         Severe brain injury from trauma,           Severe brain injury from trauma,
               cerebral vascular accident, anoxic         cerebral vascular accident, anoxic
               event, other                               event, other

Meets          Yes                                        No
Criteria for
Brain Death

Diagnosis/     Brain Death                                No chance of survival from brain
Prognosis                                                 injury; cannot survive without
                                                          mechanical ventilation and artificial

Action          Referral to OPO at imminent death         Referral to OPO at imminent death
                Brain death is declared by a              Family and physician elect to
                 physician                                  withdraw treatment
                Patient is on ventilator until organs     Referral to OPO for evaluation
                 are recovered
                                                           Withdrawal of treatment in
                Transplant team recovers organs            operating room or intensive care
                Heart, lungs, liver, pancreas, kidneys     unit
                 and intestines can be recovered           Cardiac death declared by a
                                                            ▪  Unresponsive
                                                            ▪  No pulse
                                                            ▪  No cardiac sounds
                                                            ▪  No spontaneous respirations
                                                            ▪  No blood pressure
                                                           Transplant team begins organ
                                                            recovery 5 minutes after
                                                            declaration of death
                                                           Transplant team recovers organs
                                                           Kidneys can be recovered with a
                                                            possibility of other organs
How Hospital Staff
Plays a Role in DCD
Staff responsibilities vary depending on hospital DCD protocols, the
individuals involved, and the needs of the family.

Here are some general guidelines:


 Manages patient care
 Works to preserve life before judgment is made to withdraw treatment
 Serves as an advocate for the family
 Ensures OPO is contacted to offer donation option(s)
 Declares patient cardiac dead in the operating room or ICU


 Provides ongoing care to families throughout the patient’s

 Coordinates the clinical management of the patient and support
  for the family

 Makes the referral call to OPO about the potential DCD donor before
  treatment is withdrawn


 Meets spiritual, religious and other needs of the patient and family
 Serves as family advocate in collaboration with medical and
  nursing staff
    How the DCD PROCESS WORKS                                                             coordinator, staff and family discuss the possibility that the patient will not

    The DCD process is not more difficult or complex than donation after brain            expire within the timeframe needed for donation. Typically, this means the

    death. The needs and wishes of the patient’s family are always kept in focus by       patient is returned to a unit for comfort measures. This does not mean the

    the medical team and by OPO staff members. The donation decision is made in           patient will get better, but that organ donation is not possible.

    the midst of enormous personal loss. Sensitivity, the willingness to listen and the   Step Four — DONOR MANAGEMENT ICU CARE
    ability to explain procedures in common terms can make organ donation an              The OPO personnel evaluates the suitability of the donor’s organs and

    easier decision for families to make. It is a compassionate team effort.              performs any tests necessary for evaluation. The organs are placed with

    Step One — AN END-OF-LIFE DECISION                                                    recipients listed on the transplant waiting lists.

    For a patient with a severe brain injury, the medical team meets with the             Step Five — WITHDRAWAL OF SUPPORT
    family to explain the nature of their loved one’s injury and prognosis. After         When the hospital staff and family are ready, the OPO and hospital staff
    exhausting all medical options, the medical team consults with the family             transfer the donor to the OR. When treatment is withdrawn the patient’s
    regarding their wishes about the decision to withdraw treatment. The                  physician declares cardiac death and the recovery process takes place.

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    decision to withdraw treatment is made by the family.
                                                                                          Step Six — WITHDRAWAL OF LIFE SUPPORT
    Step Two — EVALUATION                                                                 During transfer to the OR, the donor is supported on a ventilator and
    After the decision has been made to withdraw treatment, the OPO                       monitored by the surgical team and hospital staff. Once in the OR,
    determines the patient’s suitability for organ donation. The OPO                      medications are administered for organ viability and comfort care. When
    coordinator and the healthcare professional at the hospital coordinate                the team is ready, the donor is extubated. As in all settings where support is
    the donation process, including a respiratory assessment, organ function              withdrawn, comfort measures for the donor are of the utmost importance.

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    assessment and review of medical/social history.
                                                                                          Step Seven — SURGICAL RECOVERY
    Step Three — CONSENT                                                                  A hospital staff member declares cardiac death. The OPO surgical team
    After the OPO determines the patient may be a DCD donor, an OPO                       waits an additional two to five minutes to ensure the patient’s heart does
    representative approaches the family about donation. It is important to               not start beating again. Research has shown that a patient’s heart will not
    discuss donation in a quiet, private setting where the family feels most              start beating again beyond two minutes after the declaration of cardiac
    comfortable. The family is assured that organ donation still allows for an            death. After waiting five minutes, the organ recovery begins. If the patient
    autopsy, open casket funeral or memorial service, and that the donation               does not expire within one hour, the medical staff transfers the patient to a
    occurs at no cost to them. Most importantly, the family is told that their            location as outlined according to hospital policy and the attending physician
    loved one’s donation will save lives. The OPO coordinates the organ                   is contacted.
    donation process. Timing of funeral arrangements is discussed. If the family
    is agreeable to organ donation, consent is obtained. Additionally, the OPO
Questions About DCD

Organ donation can raise a variety of questions. All major religions support
organ donation and view it as an act of charity. Questions include:

Will the family be with their loved one at the end of life?
The family is allowed as much time as needed to say goodbye to their love
one. Depending on policies those families who wish to be present at the
end of life may do so.

When organs are removed, is the patient really dead?
Organs are never recovered from a patient until he or she is declared dead
by a physician. With DCD, the patient is declared dead by cardiac death
criteria (absence of spontaneous respirations and heart beat) prior to the
start of the recovery procedure.

Does the patient suffer pain during organ recovery?
After a patient dies, he or she no longer feels pain. Organ recovery occurs
only after a patient is declared dead.                                         How You Can Facilitate DCD
                                                                               in Your Hospital
Are medical professionals hastening the death of the patient?
Patients considered for DCD have suffered a devastating brain injury. Family    Commit to honor all families’ desire for organ donation
members – in consultation with the patient’s physician – decide whether          whether through brain death or cardiac death.

treatment should be withdrawn. The decision to withdraw treatment and           Collaborate with Southwest Transplant Alliance to support
the decision to donate organs are independent of one another.                    the development and implementation of DCD protocols.
                                                                                Contact Southwest Transplant Alliance to obtain education
Is there a conflict of interest for the OPO?                                     – we provide the information and training needed to assist the
The OPO is contacted when death is imminent or after the determination           hospital in developing DCD protocols.
to withdraw life treatment has been made by the family and physician. The
role of the OPO is to educate hospital staff, ensure every family is offered
the option of donation, and honor the wishes of patients and their families.
Southwest Transplant Alliance is dedicated to recovering organs and
tissue for individuals needing transplants. Southwest Transplant Alliance
and its hospital partners serve men, women and children in more than
200 hospitals in Southeast, North and West Texas.

Mission Statement
Southwest Transplant Alliance exists to save and improve lives by providing
organs and tissue for transplantation.

We distinguish ourselves by forging meaningful relationships with
donor families and the communities we serve in order to realize every
possible donation.

Vision Statement
Every organ and tissue donation opportunity is realized as long as the
need exists.

For further information contact,

    3710 Rawlins • Suite 1100
    Dallas, Texas 75219

    Corpus Christi
    El Paso