Donation after Cardiac Death (DCD)

In June 2006, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released Revisions to Standards LD.3.110 that require all hospitals to have an organ donation policy that addresses opportunities for asystolic recovery/Donation after Cardiac Death (DCD).  LifeBanc has introduced a DCD protocol that will allow some individuals who are being removed from ventilator support, but who do not meet brain death criteria, the option to donate organs.
If needed, LifeBanc staff can assist your staff in creating a protocol for your hospital to meet the JCAHO requirements. We encourage you to share this information with others within your hospital. The LifeBanc Hospital Relations department has created sample Hospital Policy and Procedures, Operational Decisions Worksheet and Critical Pathway for the DCD Donor regarding DCD. These tools, as well an in-service created for DCD are available to all hospitals.

Since less than 2% of the population ever meets brain death criteria and many people want the option of donation, DCD allows individuals and their families another opportunity to donate organs. Additionally, this will increase the number of organs available for the thousands of Ohioans who are currently awaiting life-saving transplants.

DCD occurs when a ventilator-dependent patient has an irreversible, non-survivable brain injury that never progresses to brain death. Additionally, the patient's family may decide to take the patient off the ventilator before brain death occurs. In these cases organ donation may still be an option.

LifeBanc - has a Donation after Cardiac Death (DCD) protocol that contains the following key points:

  • The potential DCD donor will have sustained an irreversible, non-survivable brain injury due to trauma, stroke, anoxia (lack of oxygen), etc.

  • The discussion of organ donation options will occur only after the family's decision to withdraw ventilator support.

  • The attending physician will pronounce death following irreversible stoppage of the heart and respiratory functions (breathing).
The protocol follows guidelines published by the Institute of Medicine (IOM) in 1997 and 2000. The protocol went through a two-year review process with the Ohio organ procurement organizations and the Ethics Committee of the Ohio Solid Organ Transplant Consortium (OSOTC). In 2001, the OSOTC Board approved the draft and in May 2002, LifeBanc's Board of Trustees approved the protocol.
Discontinuation of Ventilator Support
Only after the family has been informed that the patient's condition is terminal and they've made the decision to terminate ventilator support, will a member of the LifeBanc staff approach the family with the option of organ/tissue donation. Prior to speaking to the family, a LifeBanc staff member may consult with the hospital staff regarding their participation in this discussion.

Until death has been declared, care for the patient remains the responsibility of the attending physician or his or her designee. Once authorization for organ donation has been obtained, LifeBanc will confirm that there is a Do Not Resuscitate (DNR) order - in accordance with Ohio's DNR law - and that it has been entered in the patient's chart by the attending physician or his or her designee.

LifeBanc employees, associated recovery teams and recovery surgeons will not give orders or write orders in the patient's chart prior to the pronouncement of death.

Time of Death
The cessation of the heartbeat should take place within three hours of discontinuing ventilator support, with a five-minute interval between the pronouncement of death and the actual organ recovery. As with all organ and tissue donors, the physician who declares death is not a member of the transplant/recovery team.

The donation process will not be initiated until documentation of the date and time of death is placed in the patient's progress notes, in accordance with hospital protocol for documentation of death.
Organ Donation
Organ donation may be an option for the individual's family because the person has been on a ventilator, which kept the heart beating and oxygen-rich blood flowing to all of the vital organs. As long as the ventilator is maintained adequately, organ function can usually be sustained. However, because of the amount of time organs are without oxygenation through the DCD protocol, generally, the liver, kidneys and lungs are recovered for transplantation.

The individual remains in the critical care unit until it is time to discontinue ventilator support. Removal from the ventilator takes place in the operating room or Post Anesthesia Care Unit to facilitate the removal of donated organs. Once the person is removed from the ventilator, there has been no heartbeat or respiration for at least five minutes and the attending physician or his or her designee declares death, the transplant surgeons complete the surgical recovery of the organs. A LifeBanc staff member remains with the individual throughout the recovery procedure.

Donation and transplantation offer a second chance at life for people who have end-stage organ failure. Many donor families report donation has enabled them to feel something positive come from a tragic event.

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