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Organ Donation after Circulatory Death (DCD) (2.07)

Organ Donation after Circulatory Death (DCD) (2.07) - Policies, Clinical, UWHC Clinical, Department Specific, UW Organ and Tissue Donation

2.07



POLICY
Established Date: June 2007
Effective Date: January 2018
Title: Organ Donation after Circulatory Death (DCD) Policy Number: 2.07

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 1 of 4

PURPOSE
The purpose of this policy is to establish a standard process for University of Wisconsin Organ and Tissue
Donation (UW OTD) staff to identify patients who may be eligible for Donation after Circulatory Death
(DCD) and to facilitate the recovery of organs from DCD patients.

FORMS

DCD Tool
DCD “N” Tool
DCD Consent
Operating Room Checklist
Anesthesia Guidelines

POLICY

DCD Eligibility
A. A patient who has suffered devastating and irreversible brain injury and may be near death, but
does not meet formal brain death criteria. In these cases, the Donor Service Area (DSA) hospital
staff and the Legal Next of Kin (LNOK) have decided to withdraw life sustaining medical
treatment.
B. The decision to withdraw life sustaining medical treatment will be documented in the patient’s
Electronic Medical Record (EMR) prior to UW OTD staff initiating any discussion with the LNOK
about organ donation.
C. The Organ Procurement Coordinator (OPC) will obtain information about the patient’s
neurological and medical status from the DSA hospital staff and the patient’s EMR.
D. A patient will be initially evaluated for organ donation eligibility per UW OTD policy 2.01.
E. An additional assessment is made as to whether death is likely to occur within 120 minutes or
other timeframe established by potential transplant centers after the withdrawal of life
sustaining medical treatment because organ donation efforts may cease if death does not occur
within 120 minutes or other determined timeframe.
F. A DCD Tool or DCD “N” Tool may be used to help predict the likelihood of death within the
appropriate length of time after the patient is extubated.



POLICY
Established Date: June 2007
Effective Date: January 2018
Title: Organ Donation after Circulatory Death (DCD) Policy Number: 2.07

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 2 of 4
G. The OPC will communicate the assessment tool findings, neurological status, and EMR
information to the UW OTD Medical Director On-Call (MOC) who will make the final
determination as to whether the patient is eligible for DCD donation.
H. Other non-neurological conditions that may lead to consideration of DCD eligibility include, but
are not limited to, end-stage musculoskeletal disease, pulmonary disease, and high spinal cord
injury.
I. For conditions involving a patient being medically treated and/or supported in a conscious
neurological state, the OPC will confirm the DSA hospital team has assessed the patient’s
competency and capacity to make withdrawal of life-sustaining medical treatment and/or other
medical decisions.
DCD Consent
J. Organ donation consent will be obtained per UW OTD policy 2.06.
K. Additional consent for DCD related pre-mortem procedures and medications will be obtained
from the LNOK using a DSA hospital procedural consent form or a form provided by UW OTD.

Patient Evaluation and Management
L. The DSA hospital team will care for and medically manage the patient until declaration of death.
M. UW OTD will provide guidelines for the care of patients to maintain organ viability and maximize
donation. These are guidelines only and any changes in the treatment plan will come solely
from the DSA hospital team caring for the patient.
N. UW OTD will follow the processes for patient assessment and management per UW OTD policy
2.03.

Declaration of Cardiac Death and Organ Recovery
O. UW OTD staff will begin Operating Room (OR) preparations per UW OTD policy 3.11 and the DSA
hospital will perform all necessary and consented surgical and/or organ recovery preparation
procedures.
P. The withdrawal of life-sustaining medical treatment will typically occur in the DSA hospital OR.
There may be circumstances for a withdrawal of medical treatment to occur in a DSA hospital
Intensive Care Unit (ICU) or other appropriate location. These situations will be reviewed and
approved by the UW OTD Administrator On-Call (AOC) and/or MOC.
Q. UW OTD staff will notify DSA hospital anesthesia staff and/or attending staff if reintubation is
anticipated due to an anticipated lung recovery.



POLICY
Established Date: June 2007
Effective Date: January 2018
Title: Organ Donation after Circulatory Death (DCD) Policy Number: 2.07

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 3 of 4
1. The OPC will fax the Anesthesia Guidelines and Operating Room Checklist to the DSA
hospital OR.
2. Prior to the patient being transferred to the OR, the OPC will meet with the ICU staff to
discuss roles and responsibilities.
3. Prior to the patient being transferred to the OR, the OPC and recovery team members
will meet with the patient’s family for introductions and to answer potential questions.
4. DSA hospital staff will designate a staff member that will facilitate the reintubation if
needed.
5. UW OTD staff and designated staff will determine if the patient will be reintubated with
manual ventilation, a ventilator, a portable ventilator, or an anesthesia machine.
R. Prior to the withdrawal of life sustaining medical treatment, a timeout will be conducted by UW
OTD staff with DSA hospital staff.
S. Only a DSA hospital physician or his/her designee who is not a member of the UW OTD staff, an
organ recovery team, or transplant center will be present for the withdrawal of life sustaining
medical treatment and to give orders for comfort medications.
T. The OPC or Surgical Recovery Coordinator (SRC), acting in the role of an OPC as approved by an
UW OTD AOC, will be present for the withdrawal of life sustaining medical treatment to provide
support to the ICU staff and family (when present), as well as document required information
and timepoints.
U. The SRC will be present to provide family support (when present) and to facilitate
communication between recovery team personnel and/or DSA hospital OR staff.
V. No members of a recovery team except the OPC and SRC staff will be in the OR with the patient
from the time of the withdrawal of life sustaining medical treatment until death has been
declared.
W. Family members of the patient may be present in the OR after the patient is prepared for the
withdrawal of life sustaining medical treatment according to DSA hospital policy.
1. The family will be assisted by DSA hospital staff and/or UW OTD staff.
2. The family may remain with the patient as long as they choose or until cessation of the
patient’s circulatory and respiratory function.
3. When the family elects to leave the room or when cessation of patient’s circulatory and
respiratory function is noted, the family will be escorted to a pre-determined location by
DSA hospital staff and/or UW OTD staff.
X. An OPC or SRC acting in the OPC’s role will record vital signs per United Network of Organ
Sharing (UNOS) requirements.



POLICY
Established Date: June 2007
Effective Date: January 2018
Title: Organ Donation after Circulatory Death (DCD) Policy Number: 2.07

Electronically Approved By: Michael E. Anderson, PA-C Anthony M. D’Alessandro, M.D.
Executive Director Medical Director


Page 4 of 4
Y. The DSA hospital physician or his/her designee will declare death per DSA hospital policy and
applicable state law.
1. The DSA hospital physician or his/her designee will monitor the patient and note the
time of cessation of circulatory and respiratory function in the patient’s EMR.
2. When cessation of circulatory and respiratory function is noted, a waiting period of no
less than five minutes will be observed prior to the declaration of death to ensure that
autoresuscitation does not occur. If there is no autoresuscitation during this time, the
cardiac time of death will be declared and noted in the patient’s EMR.
3. The cardiac time of death information will immediately be provided to UW OTD staff
present in the room who will then begin the organ recovery per DSA hospital policy and
UW OTD policy 3.11.
Z. After the cardiac time of death has been declared, the patient will be reintubated by the pre-
determined designated staff if there is an anticipated lung recovery.
AA. If there is not cessation of the patient’s circulatory and respiratory function after 120 minutes
or other pre-determined amount of time as determined by a potential transplant center
following the withdrawal of life sustaining medical treatment, all efforts for organ donation will
cease.
1. The family of the patient will be notified.
2. The patient will be returned to a pre-determined unit for continued comfort measures
and will remain under the care of the DSA hospital team.

Financial Consideration
A. Once consent is obtained for organ donation and DCD eligibility is confirmed, UW OTD will be
financially responsible for all subsequent and additional expenses directly associated with the
evaluation and recovery of organs.
B. If organ donation does not occur following the withdrawal of life sustaining medical treatment,
expenses related to the end of life care will not be assumed by UW OTD but will be the
responsibility of the patient and will be facilitated by the DSA hospital.

REFERENCES

UW OTD Policy 2.01, 2.03, 2.06, and 3.11