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Although a large number of children’s hospitals have developed or are developing policies regarding organ donation after cardiac death, there is considerable variation among policies, including the criteria for declaring death, according to a study in the May 13 issue of The Journal of the American Medical Association.

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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