Initial Governing Body Approval Date

Department(s): Hospitalwide

Initial Governing Body Approval Date:

Policy Title: Organ Donation

Governing Body Approval of Revisions:

POLICY: THOSE HOSPITALS COMFORTABLE USING DCD

It is the policy of <ORGANIZATION NAME> to support patients and families as they make end-of-life decisions. One such decision is whether organ donation is a desired part of the end-of-life experience.

The discussion of possible organ donation must remain a separate one from all other end-of-life discussions, and follows discussions about the withholding or withdrawing of life support.

In situations where the patient/family has made the decision to withdraw or withhold artificial means of life support, and death is pronounced, donation after cardiac death (DCD) is supported by hospital leadership, the medical staff, and the area organ procurement organization (OPO), as is donation using the brain death criteria. The procedure outlined below is to be followed regardless of the criteria used to determine patient death.

POLICY: THOSE HOSPITALS NOT COMFORTABLE USING DCD

The discussion of possible organ donation must remain a separate one from all other end-of-life discussions, and follows discussions about the withholding or withdrawing of life support.

Two definitions of death are accepted for use in organ donation scenarios: brain death and cardiac death. The latter is also known as cardiac asystole. The use of brain death criteria to determine patient death is well established in clinical settings. The use of cardiac asystole, although not used by clinicians in recent years, is also recognized by regulatory agencies as an accepted determinate of patient death. Despite the acceptance of cardiac death as an accepted determinate of patient death, this definition will not be utilized at <ORGANIZATION NAME> when making decisions about withholding or withdrawing life support; therefore, will not be utilized in discussions about possible organ donation. This decision has been mutually made by Hospital and medical staff leadership.

We have apprised representatives from the area OPO of our moral and ethical objection (INSERT OTHER REASONS IDENTIFIED BY LEADERSHIP AND MEDICAL STAFF, IF APPLICABLE) to the use of cardiac death criteria. We will continue to support patients and families as they make end-of-life decisions.

The procedure outlined below is to be followed regardless of the criteria used to determine patient death.

PROCEDURE:

1. Informed Consent

1.1. Informed Consent to Withhold or Withdraw Life Support: Discussion must be held between the patient/family/healthcare surrogate and the physician responsible for the patient’s care regarding the futility of initiating life support interventions or of containing these interventions, and a mutual decision reached to withhold or withdraw life support.

1.2. Informed Consent to Donate Organs/tissue: Discussion regarding donation of organs or tissue cannot begin until informed consent to withhold or withhold life support has been obtained. The discussion regarding the option of donation must remain separate from the discussion to withhold or withdraw life support, and is the responsibility of a representative from the area OPO to obtain.

2. Patient Selection

2.1 Patients younger than 70 years of age, with no significant co-morbidities, for whom death is

anticipated shortly after removal of life support, or suffering from irreversible brain damage, are

candidates for DCD. The final decision regarding patient selection is made by representatives of

the OPO, and reflects criteria established by this agency.

2.1.1 The area OPO is to be notified in advance of withdrawal of life support for all patients in which

organ donation is a possibility

3. Determination of Patient Death

3.1 Cardiac Asystole Criteria

Following the removal of life support, the patient’s cardiac and respiratory status will be

continuously monitored for a period of 5 minutes. During this time, cardiac function will be

assessed by continuous electrocardiogram (ECG) and blood pressure will be monitored via

arterial pressure monitoring or by use of a non-invasive BP device. Death will be declared if no

spontaneous cardiac activity resumes during this 5 minute period.

3.1.1 The determination of death requires the determination of both cessation of functions and

irreversibility

3.1.2 Should cardiac and respiratory activity continue for more than 2 hours following removal of

life support, the option of donation no longer exists.

3.2 Brain Death Criteria

Two physicians not involved in the care of the patient, must declare the patient’s brain activity

to be absent.

4. Patient Care at the End of Life

4.1 Donation after Cardiac Death (DCD)

Patients for whom DCD has been determined to be the patient/family desire will be transferred to

the operating room prior to the removal of life support.

4.1.1 The operating room on-call staff will be notified of a potential organ donation

4.1.2 An operating room will be readied for possible organ recovery

4.1.3 Care of the dying patient will be provided by staff from the hospital until such time as the

patient is declared dead.

4.1.4 Families are permitted to remain with the dying patient until death is pronounced

4.1.5 Medications will be administered to maintain patient comfort during the dying process, even if

this prolongs the period from withdrawal of life support until the declaration of death.

4.1.6 With informed consent of the family, 30,000 units of heparin is to be administered prior to

asystole

4.2 Donation after Brain Death

4.2.1 Care of the dying patient will be provided by staff from the hospital until such time as the

patient is declared dead.

4.2.2 Families are permitted to remain with the dying patient until death is pronounced.

4.2.3 Medications will be administered to maintain patient comfort during the dying process.

5. Resources

5.1 Pastoral Care: Will be notified whenever the decision is made to withdraw life support

5.2 Bioethics Committee: Is available by consult whenever dilemmas in care arise, including those

involved in withholding or withdrawing life support or the decision to donate organs

6. Patient Care Following Pronouncement of Death

The transplant team will assume care of the patient following the declaration of death.

DEFINITIONS:

As used in this policy:

“Asystole” means the absence of cardiac function.

“Cardiac Death” means the cessation of cardiac function for a defined period of time.

“Brain Death” means the absence of brain activity.

“Cessation of Function” means the absence of responsiveness, heart sounds, pulse, and respiratory effort.

Brenda Gail Summers, MSN, MBA, MHA, CNA,

Senior Consultant

200 Hoods Lane | P.O. Box 1168 | Marblehead, MA 01945 | www.greeley.com

Consulting tel 888/749-3054 fax 781/639-0085 | Seminars tel 800/801-6661 fax 800/738-1553