DCD Policies Vary at Children’s Hospitals
Tuesday June 2, 2009
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Donation after cardiac death potentially permits patients who do not meet the neurological criteria for death to donate solid organs. Controlled DCD occurs after planned withdrawal of life-sustaining treatment, and uncontrolled DCD occurs after unanticipated cardiac arrest. Potential controlled DCD donors include patients with irreversible catastrophic brain injury or end-stage neuromuscular diseases.
The study of 105 facilities found 72% had DCD policies, 19% were developing policies, and 7% neither had nor were developing policies.
Of those with policies, 84% specified criteria or tests for declaring death, including ECG findings, pulselessness, apnea, and unresponsiveness. Eighty-eight percent precluded transplant personnel from declaring death and 51% prohibit them from involvement in premortem management. While 89% of policies indicated the importance of palliative care, only 7% recommended or required palliative care consultation. Forty-four percent precluded the use of medications with the intention to hasten death.
Policies differ in the location of withdrawal of life-sustaining treatment; 93% specify the location, with the majority (54%) requiring withdrawal of treatment to occur in the operating room. Other potential locations include areas adjacent to the operating room (19%), the ED (4%), or the ICU (4%).
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