Donation After Cardiac Death
Donation after Cardiac Death (DCD) was how human organs were originally recovered. This procedure was called “Non Heart Beating Donor” because in order to procure organs, the donor had to be “cardiac dead” due to there not being a concept of brain death. DCD’s today occupy approximately 10-20% of all organs recovered for transplantation depending on the OPO.
A patient who has a non-recoverable and irreversible neurological injury resulting in ventilator dependency but not fulfilling brain death criteria may be a suitable candidate for donation after cardiac death. Other conditions may include end stage musculoskeletal disease, pulmonary disease, and high spinal cord injury.
The decision to withdraw life-sustaining measures must be made by the hospital’s patient care team and legal next of kin, and documented in the patient chart.” Depending on the circumstances, the “legal next of kin” may be a relative, a designated health care representative, or an appropriate surrogate.
The assessment of potential donors should be conducted in collaboration with the local organ procurement organization and the patient’s primary health care team.
An assessment should be made as to whether death is likely to occur (after the withdrawal of life-sustaining measures) within a time frame that allows for organ donation. The assessment usually done measures respiratory drive, hemodynamic status and patient demographics, depending on a score based result, the patient may have a higher or lower chance of cardiac expiring in predetermined time. Most aggressive transplant centers will give about 15-30 minutes post extubation to recover liver and up to 60 minutes for the kidneys. This time frame varies from center to center.
The University of Wisconsin DCD Evaluation Tool is composed of a numeric scale from 7 to 21. The higher the score, the less time it takes for the patient to expire.
After a patient is referred to the OPO, the patient’s physician grants permission for the DCD evaluation. The potential for organ donation pending the results of a bedside evaluation is explained to the family of each patient. The risk of cardiac arrest during the evaluation is explained to the family as part of gaining their consent before proceeding. The Donor Management Coordinator guides the donor hospital staff for the DCD evaluation.
After tabulating the patient’s score, the results are evaluated with clinical/medical director. The patient’s medical and social history is also reviewed in order to determine DCD suitability. This system allows the OPO to screen potential DCD donors before committing further resources and offering the option of DCD appropriately to families. The OPO defines a DCD candidate as a severely neurologically injured patient who is expected to expire within 120 minutes following extubation.