When Do DCD Donors Die?

Scalea, Joseph R.; Redfield, Robert; Rizzari, Michael; Bennett, Ryan J.; Anderson, Michael E.; Anderson, John M.; Kaufman, Dixon B.; Sollinger, Hans W.; Fernández, Luis A.; D’Alessandro, Anthony M.; Mezrich, Joshua D.

doi:10.1097/sla.0000000000001298

Cited by 33 publications

(8 citation statements)

References 24 publications

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“…The age of potential donors (n=12) ranged from 18 to 64 years and all had suffered serious brain damage due to a range of causes, including cerebrovascular event (5) and trauma (2), but did not meet criteria for brain death. Respondents included parents (7), spouses or domestic partners (4), siblings (2), child (1) or aunt (1) of the deceased. Most respondents were white and Christian, consistent with the demographics of the population served by the UW OPO.…”

Section: Resultsmentioning

confidence: 99%

“…However, successful donation requires potential donors to progress to circulatory death within a predetermined time frame before organ damage from hypoxia and hypotension preclude transplantation. (3, 4)…”

Section: Introductionmentioning

confidence: 99%

“…(4) Furthermore, despite terminal illness, the donation process is not even attempted for some patients as available tools predict they will not progress. While organ donation may have great benefit for grieving families,(5–7) our current system leaves the wishes of many families and donors unfulfilled and a shortage of available organs persists.…”

Section: Introductionmentioning

confidence: 99%

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Harms of unsuccessful donation after circulatory death: An exploratory study

Taylor

Buffington

Scalea

et al. 2018

American Journal of Transplantation

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While donation after circulatory death (DCD) has expanded options for organ donation, many who wish to donate are still unable to do so. We conducted face-to-face interviews with family members (N = 15) who had direct experience with unsuccessful DCD and 5 focus groups with professionals involved in the donation process. We used qualitative content analysis to characterize the harms of nondonation as perceived by participants. Participants reported a broad spectrum of harms affecting organ recipients, donors, and donor families. Harms included waste of precious life-giving organs and hospital resources, inability to honor the donor's memory and character, and impaired ability for families to make sense of tragedy and cope with loss. Donor families empathized with the initial hope and ultimate despair of potential recipients who must continue their wait on the transplant list. Focus group members reinforced these findings and highlighted the struggle of families to navigate the uncertainty regarding the timing of death during the donation process. While families reported significant harm, many appreciated the donation attempt. These findings highlight the importance of organ donation to donor families and the difficult experiences associated with current processes that could inform development of alternative donation strategies.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Harms of unsuccessful donation after circulatory death: An exploratory study

Taylor

Buffington

Scalea

et al. 2018

American Journal of Transplantation

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“…Further, knowledge about the cellular processes in the brain taking place after circulatory arrest is important to determine how much time should pass between cardiac standstill and organ procurement ( 3 , 5 ). This is an important ethical problem because the amount of time elapsed is positively correlated with the certainty of lost brain function but negatively with the tissue quality of organ transplants ( 3 , 5 – 7 ). Recent attempts of brain resuscitation in an animal model add another layer of complexity ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

The Neurology of Death and the Dying Brain: A Pictorial Essay

Kondziella

2020

Front. Neurol.

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As neurologists earn their living with the preservation and restoration of brain function, they are also well-positioned to address the science behind the transition from life to death. This essay in pictures highlights areas of neurological expertise needed for brain death determination; shows pitfalls to avoid during the clinical examination and interpretation of confirmatory laboratory tests in brain death protocols; illustrates the great variability of brain death legislations around the world; discusses arguments for the implementation of donation after circulatory death (DCD); points to unresolved questions related to DCD and the time between cardiac standstill and organ procurement ("hands-off period"); provides an overview of the epidemiology and semiology of near-death experiences, including their importance for religion, literature, and the visual arts; suggests biological mechanisms for near-death experiences such as dysfunction of temporoparietal cortex, N-methyl-D-aspartate receptor antagonism, migraine aura, and rapid eye movement sleep; hypothesizes that thanatosis (aka. death-feigning, a common behavioral trait in the animal kingdom) represents the evolutionary origin of neardeath experiences; and speculates about the future implications of recent attempts of brain resuscitation in an animal model. The aim is to provide the reader with a thorough understanding that the boundaries within the neurology of death and the dying brain are being pushed just like everywhere else in the clinical neurosciences.

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“…Approximately one-third of potential DCD donors do not die before their organs have suffered too much ischemia to make donation possible. 11 Families have described “hoping for death in time” as very difficult, and the death that occurs beyond a time where organs can be safely transplanted as a “second loss.” 9 , 12 During the dying process after WLSM, ethical and legal tensions and questions arise despite the agreement that fulfilling the wish of the dying patient to be a donor and providing a comfortable death are goals of the process. For example, these goals must be achieved without expediting death for donation as this would be illegal in 2020, outside of the context of medical assistance in dying.…”

mentioning

confidence: 99%

Improving quality of withdrawal of life-sustaining measures in organ donation: a framework and implementation toolkit

Healey

Hartwick

Downar

et al. 2020

Can J Anesth/J Can Anesth

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Background Donation after circulatory determination of death (DCD) is responsible for the largest increase in deceased donation over the past decade. When the Canadian DCD guideline was published in 2006, it included recommendations to create standard policies and procedures for withdrawal of life-sustaining measures (WLSM) as well as quality assurance frameworks for this practice. In 2016, the Canadian Critical Care Society produced a guideline for WLSM that requires modifications to facilitate implementation when DCD is part of the endof-life care plan.

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When Do DCD Donors Die?

Abstract: DCD is an important form of organ donation. A large number of abdominal transplants are not possible due to unsuccessful DCD organ donation. It may be useful to explore DCD donor family satisfaction to identify other options for improving DCD donation.

Cited by 33 publications

References 24 publications

Harms of unsuccessful donation after circulatory death: An exploratory study

Harms of unsuccessful donation after circulatory death: An exploratory study

The Neurology of Death and the Dying Brain: A Pictorial Essay

Improving quality of withdrawal of life-sustaining measures in organ donation: a framework and implementation toolkit

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