Transcript Donation After Cardiac Death

Donation After Cardiac Death
Margie Whittaker RN, MSN, CCRN,
CNRN
April 12, 2010
Anne’s Story
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RN colleague collapsed while at work
SAH with extensive bleeding
Poor prognosis
Family wishes to donate organs to honor Anne
Did not progress to brain death
After 48 hours of waiting, withdrawal of life
support occurred and Anne died within about 30
minutes
DCD actions
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Collaborated with Onelegacy
 Researched and presented at committees
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Critical care
Ethics
Surgery
Hospital and system administration
6 months later policy was complete with
revisions occurring every couple of years
DCD today
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Goal is 10% of organ donations are from
DCD
 Accepted as medically effective and
ethically acceptable approach to support the
need for organs
 Joint Commission states policy to offer
DCD must be in place (can be transfer
agreement)
 Locally and nationally we are still falling
short of our goal
Challenges
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End of Life care
 Knowledge of DCD process
 Controlled vs uncontrolled DCD
 Knowledge of related ethical principles
 Fewer patients due to improved outcomes
of TBI and stroke care
End of Life Care
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Good end of life care in critical care does
not always occur
 Technology vs patient’s wishes
 Family unwilling/unable to make decisions
– Society
– Health care reform
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Healthcare team unwilling/unable to offer
different plan of care
Knowledge of DCD process
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Triggers and referral should be in place as
patients’ meet criteria for evaluation
Understanding of brain death declaration
Devastating neurological injury, dependent on
ventilator and family considering withdrawal of
life support to allow a natural death
Comfort or palliative care for patient
Studies show critical care staff do not know when
to offer DCD
Controlled vs Uncontrolled
DCD
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Controlled DCD equals time to make decision
 Death is anticipated
 Withdrawal of care is planned
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Uncontrolled DCD equals compressed decision
time
 Frequently in ED/trauma
 Planning is minimal
Ethical Principles
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Ethical principles around organ donation continue
to be discussed and studied
Primary discussion is around “dead donor rule”
Allowing patients to die for organ gains
Use of ECMO after cardiac/respiratory cessation
Honoring wishes and rights of first person consent
for SCI or ALS patients
Analgesia at time of withdrawal
Our Responsibility
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Refer according to the triggers: use our
resources
 Know hospital policies and be ready with
answers for those who have questions
 Advocate for patient and right to participate
in health care decision making throughout
life span
 Commit to honoring patient’s wishes
Questions?
[email protected]