Donation after cardiac death (DCD) is an organ procurement process for transplantation in patients with irreversible brain injuries who do not meet the formal criteria of brain death. These patients are transitioned to “comfort measures only”, liberated from the mechanical ventilator, and given 60-120 minutes (depending on the institution) for cardiopulmonary death. After death pronouncement, organ procurement begins in the operating room (OR).
The ICU-trained anesthesiologists at my institution have an agreement with our organ procurement organization (OPO), LifeGift, and the hospital where we aim to streamline this process. As with any organ donation process, coordination is essential. The OPO has a discussion about DCD with the patient’s family, procuring surgeons are contacted, and a tentative OR time is set.
Regardless of where the patient is in the hospital (e.g., neurointensive care unit), they are brought down to the post-anesthesia care unit (PACU) as this area is adjacent to the ORs. A moment of silence is held with the family at the bedside, additional comfort medications are used to alleviate any component of air hunger, pain, anxiety, etc., and the patient is extubated by a respiratory therapist.
At this time, we emphasize that the family focuses on spending time with their loved one. It’s never clear how long patients will maintain circulatory function, but the moment they are in asystole, I do a circulatory death pronouncement and exam. To avoid ongoing organ damage, I will quickly take the patient back to the OR, transition them to the OR table, re-pronounce, and let the organ procurement surgery begin. I then document a DCD summary note.
DCD allows more organs to be available to recipients who are on the transplant list. These are the ultimate gifts of selflessness, and consequently, the entire organ procurement team takes this process seriously.
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