ORGAN DONATION FOLLOWING CIRCULATORY DEATH (DCD)
Imminent Death defined by CMS
• A patient:
o With severe, acute brain injury
o Who requires mechanical ventilation
o Who is in an ICU or Emergency Department
AND
o Has clinical findings consistent with a GCS that is less than or equal to a mutually-agreed-upon threshold (GCS <5)
OR
o Whose physicians are evaluating a diagnosis of brain death
OR
o Whose physician has ordered that life-sustaining therapies be withdrawn, pursuant to the family’s decision
DCD Defined
Organ procurement following pronouncement of death based on the irreversible cessation of circulatory functions.
• A patient:
o With severe, acute brain injury
o Who requires mechanical ventilation
o Who is in an ICU or Emergency Department
AND
o Has clinical findings consistent with a GCS that is less than or equal to a mutually-agreed-upon threshold (GCS <5)
OR
o Whose physicians are evaluating a diagnosis of brain death
OR
o Whose physician has ordered that life-sustaining therapies be withdrawn, pursuant to the family’s decision
DCD Defined
Organ procurement following pronouncement of death based on the irreversible cessation of circulatory functions.
What does circulatory death mean?
Circulatory death occurs when the heart stops beating.
What does donation after circulatory death (DCD) mean?
Donation after circulatory death means that after the heart has stopped beating and death is pronounced by a physician, organs and tissues may be recovered and offered for transplant.
Who can be a DCD donor?
A patient who has a severe neurological injury such as a stroke, bleeding into the brain, trauma or suffocation may be a DCD donor. Patients who have amyotrophic lateral sclerosis, or ALS, as well as patients with spinal cord injuries, may also be DCD donors. With these kinds of serious injuries, the brain is too damaged to recover but continues to have minimal function. However, the patient will not survive without ventilator support.
What is ventilator support?
A ventilator is a machine that “breathes” for a patient when the patient is not able to breathe on his or her own. Ventilators, sometimes called respirators, provide oxygen to the lungs through a tube that is placed in the patient’s throat. When the brain is too damaged to recover, it can’t instruct the lungs to keep breathing or the heart to keep beating. In order to sustain life, the patient needs ventilator support. Ventilators are common in hospitals.
What is the situation that leads up to a DCD donation?
Once the hospital medical team has determined that the patient will not survive or have any meaningful improvement even with ongoing care, including ventilator support, a family may elect to discontinue or forgo further medical intervention. This careful decision includes withdrawal of support, or removing the ventilator, allowing death to occur naturally.
What happens once the family decides to withdraw ventilator support?
After the family makes the decision to stop ventilator support, they will be guided through some end-of-life decisions, including decisions about organ and tissue donation.
LifeShare, which is responsible for helping with organ donation and transplantation, will be notified. A LifeShare coordinator will examine the patient and work with the hospital staff to determine if a patient is suitable to be a donor. If the patient can be a donor, the coordinator will speak with the family about organ and tissue donation.
What happens before the ventilator is discontinued?
Until the time of death, the patient remains under the care of the hospital physician and medical team. All comfort measures are maintained and care is never compromised. The patient will continue to receive pain medication and other treatments that relieve any discomfort. If the family chooses, they may be able to remain present and follow rituals that are important for end of life, such as prayers, music or inviting those close to the patient to be present.
What happens next?
If the patient has not previously registered as a donor, LifeShare will obtain authorization from the legal next-of-kin, as well as an extensive medical and social history. Some blood may be drawn for testing. This is a routine procedure and part of the process that ensures the patient can be a donor.
The donation process will be explained, including what will happen when the ventilator is turned off and the patient’s heart stops beating. The LifeShare coordinator and the hospital staff will work together to offer support for the patient, family and others who may be part of this experience.
Once donation is authorized, care for the patient does not change. All care and comfort measures will continue until the patient’s death.
Will our religion support our decision about organ and tissue donation?
All major religions support organ and tissue donation as an unselfish act of charity. However, you should feel free to speak with your religious leader.
Circulatory death occurs when the heart stops beating.
What does donation after circulatory death (DCD) mean?
Donation after circulatory death means that after the heart has stopped beating and death is pronounced by a physician, organs and tissues may be recovered and offered for transplant.
Who can be a DCD donor?
A patient who has a severe neurological injury such as a stroke, bleeding into the brain, trauma or suffocation may be a DCD donor. Patients who have amyotrophic lateral sclerosis, or ALS, as well as patients with spinal cord injuries, may also be DCD donors. With these kinds of serious injuries, the brain is too damaged to recover but continues to have minimal function. However, the patient will not survive without ventilator support.
What is ventilator support?
A ventilator is a machine that “breathes” for a patient when the patient is not able to breathe on his or her own. Ventilators, sometimes called respirators, provide oxygen to the lungs through a tube that is placed in the patient’s throat. When the brain is too damaged to recover, it can’t instruct the lungs to keep breathing or the heart to keep beating. In order to sustain life, the patient needs ventilator support. Ventilators are common in hospitals.
What is the situation that leads up to a DCD donation?
Once the hospital medical team has determined that the patient will not survive or have any meaningful improvement even with ongoing care, including ventilator support, a family may elect to discontinue or forgo further medical intervention. This careful decision includes withdrawal of support, or removing the ventilator, allowing death to occur naturally.
What happens once the family decides to withdraw ventilator support?
After the family makes the decision to stop ventilator support, they will be guided through some end-of-life decisions, including decisions about organ and tissue donation.
LifeShare, which is responsible for helping with organ donation and transplantation, will be notified. A LifeShare coordinator will examine the patient and work with the hospital staff to determine if a patient is suitable to be a donor. If the patient can be a donor, the coordinator will speak with the family about organ and tissue donation.
What happens before the ventilator is discontinued?
Until the time of death, the patient remains under the care of the hospital physician and medical team. All comfort measures are maintained and care is never compromised. The patient will continue to receive pain medication and other treatments that relieve any discomfort. If the family chooses, they may be able to remain present and follow rituals that are important for end of life, such as prayers, music or inviting those close to the patient to be present.
What happens next?
If the patient has not previously registered as a donor, LifeShare will obtain authorization from the legal next-of-kin, as well as an extensive medical and social history. Some blood may be drawn for testing. This is a routine procedure and part of the process that ensures the patient can be a donor.
The donation process will be explained, including what will happen when the ventilator is turned off and the patient’s heart stops beating. The LifeShare coordinator and the hospital staff will work together to offer support for the patient, family and others who may be part of this experience.
Once donation is authorized, care for the patient does not change. All care and comfort measures will continue until the patient’s death.
Will our religion support our decision about organ and tissue donation?
All major religions support organ and tissue donation as an unselfish act of charity. However, you should feel free to speak with your religious leader.
How does organ recovery happen?
When everything is in place for the organ recovery, the team will assemble in the operating room. Depending on the hospital, the ventilator may be turned off either in the patient’s room, outside the operating room or in the operating room.
The hospital may offer the family the choice of being present as the patient’s heart stops beating. Once the heart stops beating, a physician from the hospital will declare death and the family will be guided out of the room. After death has been declared by the patient’s physician, a five-minute period is observed and death is confirmed. At this point, the patient will be prepared for surgery and organ recovery. A separate team of physicians and professionals will be waiting near the operating room to recover the organs. After recovery, the organs will be offered for transplant.
Does our loved one feel any pain or suffer?
No. Organ and tissue recovery does not take place until after the person’s heart stops beating and they are declared dead by a physician. When someone is deceased, they cannot feel pain or suffer.
When everything is in place for the organ recovery, the team will assemble in the operating room. Depending on the hospital, the ventilator may be turned off either in the patient’s room, outside the operating room or in the operating room.
The hospital may offer the family the choice of being present as the patient’s heart stops beating. Once the heart stops beating, a physician from the hospital will declare death and the family will be guided out of the room. After death has been declared by the patient’s physician, a five-minute period is observed and death is confirmed. At this point, the patient will be prepared for surgery and organ recovery. A separate team of physicians and professionals will be waiting near the operating room to recover the organs. After recovery, the organs will be offered for transplant.
Does our loved one feel any pain or suffer?
No. Organ and tissue recovery does not take place until after the person’s heart stops beating and they are declared dead by a physician. When someone is deceased, they cannot feel pain or suffer.
