The circulatory–respiratory determination of death in organ donation*

Bernat, James L.; Capron, Alexander Morgan; Bleck, Thomas P.; Blosser, Sandralee; Bratton, Susan L.; Childress, James F.; DeVita, Michael A.; Fulda, Gerard J.; Gries, Cynthia J.; Mathur, Mudit; Nakagawa, Thomas A.; Rushton, Cynda Hylton; Shemie, Sam D.; White, Douglas B.

doi:10.1097/ccm.0b013e3181c58916

Cited by 212 publications

(178 citation statements)

References 38 publications

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“…The Institute of Medicine recommends observing the patient for 5 minutes after cessation of circulation to preclude autoresuscitation before declaring the patient dead. 35 Only then can organ procurement proceed. There are no reported cases of autoresuscitation occurring after withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Hanley¹,

Kim

Willey

et al. 2014

Pediatrics

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BACKGROUND: Over 96 000 patients await kidney transplantation in the United States, and 35 000 more are wait-listed annually. The demand for donor kidneys far outweighs supply, resulting in significant waiting list morbidity and mortality. We sought to identify potential kidney donors among newborns because en bloc kidney transplantation donation after circulatory determination of death (DCDD) may broaden the donor pool. METHODS: We reviewed discharges from our 84-bed NICU between November 2002 and October 2012 and identified all deaths. The mode of death among potential organ donors (weight ≥1.8 kg) was recorded. Patients undergoing withdrawal of life support were further evaluated for DCDD potential. After excluding patients with medical contraindications, those with warm ischemic time (WIT) less than 120 minutes were characterized as potential kidney donors. RESULTS: There were 11 201 discharges. Of 609 deaths, 359 patients weighed ≥1.8 kg and 159 died after planned withdrawal of life support. The exact time of withdrawal could not be determined for 2 patients, and 100 had at least 1 exclusion criterion. Of the remaining patients, 42 to 57 infants were potential en bloc kidney donors depending on acceptance threshold for WIT. Applying a 40% to 70% consent rate range would yield 1.7 to 4 newborn DCDD donors per year. CONCLUSIONS: A neonatal DCDD kidney program at our institution could provide 2 to 4 paired kidneys for en bloc transplantation each year. Implementing a DCDD kidney donation program in NICUs could add a new source of donors and increase the number of kidneys available for transplantation.

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Section: Discussionmentioning

confidence: 99%

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Hanley¹,

Kim

Willey

et al. 2014

Pediatrics

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“…The most recent change in terminology emphasizes that the determination of death is based on the cessation of circulatory, not cardiac, functions. 2 ) There are several forms of DCD, and the current statement focuses on "controlled" DCD: the recovery of organs after the planned withdrawal of life-sustaining medical treatment. 3 Although DCD was the initial form of deceased organ donation, it was eclipsed by recovery of organs from individuals declared dead according to neurologic criteria after these criteria were established and evidence showed improved graft function from such donors.…”

Section: Introductionmentioning

confidence: 99%

Ethical Controversies in Organ Donation After Circulatory Death

Antommaria¹,

Fallat²,

Katz³

et al. 2013

Pediatrics

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The persistent mismatch between the supply of and need for transplantable organs has led to efforts to increase the supply, including controlled donation after circulatory death (DCD). Controlled DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria. Two central ethical issues in DCD are when organ recovery can begin and how to manage conflicts of interests. The “dead donor rule” should be maintained, and donors in cases of DCD should only be declared dead after the permanent cessation of circulatory function. Permanence is generally established by a 2- to 5-minute waiting period. Given ongoing controversy over whether the cessation must also be irreversible, physicians should not be required to participate in DCD. Because the preparation for organ recovery in DCD begins before the declaration of death, there are potential conflicts between the donor’s and recipient’s interests. These conflicts can be managed in a variety of ways, including informed consent and separating the various participants’ roles. For example, informed consent should be sought for premortem interventions to improve organ viability, and organ procurement organization personnel and members of the transplant team should not be involved in the discontinuation of life-sustaining treatment or the declaration of death. It is also important to emphasize that potential donors in cases of DCD should receive integrated interdisciplinary palliative care, including sedation and analgesia.

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“…Following withdrawal of life support, the DCD donor is declared dead based on the cardiopulmonary criteria for death. 12,13 Typically, the potential DCD donor may have end-stage neuromuscular disease, severe neurologic injury, or terminally advanced pulmonary disease. Once cardiopulmonary function has ceased, resuscitative efforts are not undertaken, and a period of five minutes is allowed to elapse prior to organ procurement in order to ensure the absence of autoresuscitation.…”

Section: Résumémentioning

confidence: 99%