Organ Donation After Cardiac Death

We never claimed the transition would go smoothly, did we? 

Our doctors may have pulled everything together to purchase the hospital and prevent it from closing… But, they're doctors. They're amazing, well-trained, world-renowned, life-saving surgeons. Most med schools don't teach Business and Management 101, and even if they did, our doctors would prefer an elective that includes scalpels and suturing. … So, what I'm saying is, we need to cut them a little slack, right? Running a hospital involves a lot of moving parts, sort of like organ donation and transplants…

What was so unique about Bradley Parker's organ donation process?

With the support of his family, Bradley made the decision to be withdrawn from the ventilator and donate his organs after cardiac death, or when his heart stopped. In recent years, most organ donations occur after brain death – when activity in the brain can no longer be detected. However, donation after cardiac death (DCD) used to serve as the main option for patients and their families to donate organs. But in the early years, DCD had its limitations in the viability of the organs that were recovered from the donor – only the kidneys seemed to maintain adequate function. Therefore, hospitals turned to donation after brain death in order to transplant more working organs such as the heart, lungs, liver, kidneys, pancreas, and intestines.

But only a small percentage of hospital deaths are brain deaths. Due to the shortage of needed organs, researchers and doctors began to look at DCD one more time as a means to acquiring healthy organs for transplant. And with the advances in medication and surgical techniques, DCD has once again become a solid option for many patients and their families.

So how does DCD work?

First, a patient may only be eligible for DCD if he or she suffers from a severe brain injury (but does not meet the criteria for brain death) or end-stage condition that has caused the patient to be ventilator-dependent (like Bradley's amyotrophic lateral sclerosis). The medical team will meet with the patient and family in order to discuss at length their wishes and all options for end of life care. If the decision to withdraw life support has been made, then the medical team will approach the patient and family about organ donation.

Then, the region's organ procurement organization (OPO) coordinates the organ donation process. A patient may consent for donation if he or she has registered with the state or a family may give consent for donation. Besides donation, the OPO also obtains written consent for other actions such as insertion of femoral cannulas and administration of certain medications to improve organ function during the recovery process. The OPO also sets up the evaluation of the patient: respiratory drive assessments, organ function assessment, and review of medical/social histories.

Additionally, the OPO must discuss with the patient and family the possibility that the patient may not expire within the necessary timeframe for donation. The time differs depending on the program, but most hospitals allow one hour for the patient to expire after being withdrawn from life support. If the patient survives past the hour, he or she will be taken out of the operating room for comfort and care measures. At this point, the patient will not recover, but unfortunately, organ donation is no longer possible.

Withdrawal of life support usually takes place in the operating room. In most hospitals, family members are allowed to remain in the operating room with their loved one until they pass. The transplant surgeons must stay outside until the family leaves before they can proceed with the recovery operation. After the patient expires, the doctor will declare cardiac death, and the family must leave the room. The transplant surgeons have a period of five minutes to start the recovery process after cardiac death has been declared – research has shown that a patient's heart will not auto-resuscitate beyond two minutes after stopping.

What are some of the benefits to DCD?

• DCD is an additional option for organ donation.

• DCD provides another way for the patient's family to celebrate the life of their loved one.

• Organs recovered from DCD have now shown to have similar outcomes as those from donations after brain death.

• According to Donate Life, implementation of DCD in U.S. hospitals could potentially save 10,000 patients a year.

• Despite the myths, DCD is not considered experimental. It is supported by the Institute of Medicine, the Society for Critical Care Medicine, and the Association of Organ Procurement Organizations.