Donation After Cardiac Death (DCD) Has Been Accepted in Many Hospitals As a Way of Increasing

JoffeJan 18, 2008

Table E1: The survey scenarios.

Scenario 1:

A 30 year old man was in a motor vehicle collision. Two weeks after the injury he is still in a coma. The doctors think that he will have very profound brain damage if he survives. He needs life support with a ventilator (breathing machine) and other medications. This man told his wife and parents a few times in the past that if he was ever in a coma and going to have severe brain damage, he wanted them to let him die. The doctors discuss this request with the family, and they decide to take him off life support and let him die.

The wife and parents say that he always wanted to donate his organs after he dies. The doctors tell them that this is possible. He can be taken to the operating room, and have the life support stopped. Five minutes after his circulation stops he will be pronounced dead. Then surgeons could make incisions to recover both his kidneys for organ donation. The family decides this is what the patient would have wanted.

The wife asks the doctors if they are sure that after 5 minutes the patient, her husband, will be dead. They answer that at the 5 minute time after circulation stops, there is no doubt that he is dead. That is why at the 5 minute time the surgeons can start making their incisions to obtain the kidneys for transplant.

Scenario 2:

A 28 year old woman has had bleeding in her brain from a brain aneurysm. After two weeks in intensive care, she has recovered with severe disability. The doctors say that she will never be able to walk or feed herself. Although she can speak a few words with people, she has severe brain damage and is mentally retarded. Two weeks later, she develops a severe pneumonia from choking on her food. She is taken back to intensive care, and needs life support with a ventilator (breathing machine). The doctors think she may not survive this pneumonia even with the breathing machine. The woman’s parents and siblings say that she told them several times before her brain aneurysm that she would not want to live if she had severe brain damage. The doctors discuss this with the family, and the family and doctors decide to take her off life support and let her die.

The family says that she always wanted to donate her organs after she dies. The doctors tell the family that this is possible. She can be taken to the operating room, and have the life support stopped. Five minutes after her circulation stops she will be pronounced dead. Then surgeons could make incisions to recover both her kidneys for organ donation. The family decides this is what the patient would have wanted.

The parents ask the doctors if they are sure that after 5 minutes the patient, their daughter, will be dead. They answer that at the 5 minute time after circulation stops, there is no doubt that she is dead. That is why at the 5 minute time the surgeons can start making their incisions to obtain the kidneys for transplant.

Scenario 3:

A 5 year old girl was hit by a car crossing the street. It is now two weeks after the injury, and she is still in a coma. She needs life support with a ventilator (breathing machine) and other medications. The doctors tell the parents that she may never wake up, and if she does, she will not be able to walk or feed herself, and will have severe mental retardation (profound brain damage). After discussion with the family and doctors, the parents decide it is best for the patient to take her off life support, and let her die.

The parents ask if the girl can donate her organs. The doctors tell the parents that this is possible. She can be taken to the operating room, and have the life support stopped. Five minutes after her circulation stops she will be pronounced dead. Then surgeons could make incisions to recover both her kidneys for organ donation. The parents decide this should be done.

Scenario 4:

A 32 year old man was in a car collision and has had a severe injury to the upper spine in the neck. This has left him permanently and completely paralyzed from the neck down, and unable to breath on his own. He has had a tracheostomy (a hole in the neck made) so that he can be on a ventilator (breathing machine) permanently. Two months later he discussed with his parents and wife that he does not want to be kept on a ventilator. He tells them that he wants to be taken off the ventilator and allowed to die. He tells them that he does not want to live paralyzed and on a ventilator. The patient, his parents, and his wife discuss this with the doctors, and it is decided to do what he wishes, and take him off the ventilator and allow him to die.

The man says he wants to donate his organs after he dies. The doctors tell him and his family that this is possible. He can be taken to the operating room, and have the life support (breathing machine) stopped. Five minutes after his circulation stops he will be

pronounced dead. Then surgeons could make incisions to recover both his kidneys for organ donation. The man and his family decide this is what they want to be done.

Table E2: Responses suggesting a possible willingness to abandon the dead donor rule: SA/A to allow DCD while D/SD that the patient is definitely dead.

Survey group / Scenario 1 / Scenario 2 / Scenario 3 / Scenario 4 / Any one scenario / All scenarios
DI (n=158) / 8 (5.1%) / 6 (3.8%) / 6 (3.8%) / 8 (5.1%) / 14 (8.9%) / 2 (1.3%)
BI (n=162) / 7 (4.3%) / 6 (3.7%) / 6 (3.7%) / 7 (4.3%) / 10 (6.2%) / 3 (1.9%)

BI: Basic information; DCD: donation after cardiac death; DI: detailed information; D/SD: disagree or strongly disagree; SA/A: strongly agree or agree. All comparisons DI to BI are not statistically significant by Chi-square test. Results are pooled for all students because there were not statistically significant differences between the student groups. This suggests there is little support to abandon the dead donor rule.