Donation after Cardiac DeathSupporting Patients and Families during End of

Life Care in the Operating Room

Douglas T Miller Symposium

Breakout Session

April 23, 2009

Donation after Cardiac Death (DCD)

• What is DCD?What is DCD?

• What is the difference between DCD What is the difference between DCD donation and donation after brain death?donation and donation after brain death?

• What is my role in supporting the What is my role in supporting the patient and family during end of life care patient and family during end of life care in the operating room?in the operating room?

National Transplant Waiting List

Type of Transplant Waiting Transplanted in ‘08 Kidney 78,957 16,514

Liver 15,768 6,318Lung 1,966 1,478Heart 2,803 2,163Heart-lung 83 27Kidney-pancreas 2,266 836Pancreas 1,552 437Intestines 213 185

Totals 101,216 27,958

Source: Organ Procurement and Transplant Network - As of 03/20/09

Wisconsin Transplant Waiting List

Type of Transplant Waiting Transplanted in ‘08

Kidney 1,057 445Liver 206 155

Lung 64 40Heart 79 29Heart-lung 0 0Kidney-pancreas 53 49Pancreas 12 15

Intestines 2 0Total 1,436 734

Source: Organ Procurement and Transplant Network, As of 03/20/09

What is DCD?

DCD is a donation opportunity for families of patients who have a non-survivable injury or illness, as determined by their physician. These patients have the ability to save the lives of others by donating their organs after being declared dead.

Donation after Brain Death and Donation after Cardiac Death

DONATION AFTER CARDIAC DEATHDONATION AFTER CARDIAC DEATH

• Severe brain injurySevere brain injury– Intracranial hemorrhage, stroke, anoxia, traumaIntracranial hemorrhage, stroke, anoxia, trauma

• Patients without brain injuryPatients without brain injury– Degenerative neuromuscular diseasesDegenerative neuromuscular diseases

– End-stage cardiopulmonary diseasesEnd-stage cardiopulmonary diseases

– High spinal cord injuryHigh spinal cord injury

• Do not meet the criteria for brain deathDo not meet the criteria for brain death

• Non-survivable injury/illness off the Non-survivable injury/illness off the ventilatorventilator

• Family and physician elect to withdraw Family and physician elect to withdraw supportsupport

• ~ 10 % of deceased organ donor nationally~ 10 % of deceased organ donor nationally

• 26 % of UWHC OPO deceased organ26 % of UWHC OPO deceased organ donorsdonors

DONATION AFTER BRAIN DEATH• Severe brain injury

– Intracranial hemorrhage, stroke, anoxia, trauma

• Meets criteria for brain death– Clinical Exam– Confirmatory Testing

• ~ 90 % of deceased organ donors nationally

• 74% of UWHC OPO deceased organ donors

Who are the candidates for DCD?

• Non-survivable injury or illness as determined by the patient’s physician

• Medically eligible for organ donation as determined by OPO medical director

• The death is expected to occur within 2 hours after withdrawal of ventilator support by the patient’s health care team

Where will the Death Occur?

• ICU– Kidneys only– Extra-Renal--ICU in close proximity to the

operating room– Family Preference

• Operating Room– Extra-Renal Organs

How long can we wait for the death to occur to recover organs?

• Lungs– 30 minutes

• Liver– 30 minutes

• Pancreas– 30-45 minutes

• Kidneys– Up to 2 hours

Presenters

• Rene Escalante, Chaplain– St. Anthony Medical Center, Rockford, IL

• Libby Ferris, Operating Room RN– St. Joseph’s Hospital, Marshfield, WI

• Amy Kroos, Palliative Care RN– St. Anthony Medical Center, Rockford, IL

• James Anderson, ST, Recovery Coord.– UW OPO

THANK YOU

QUESTIONS?