1. Donation After Cardiac Death Margie Whittaker RN, MSN, CCRN, CNRN April 12, 2010

2. Anne’s Story 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

3. DCD actions Collaborated with Onelegacy Researched and presented at committees – Critical care – Ethics – Surgery – Hospital and system administration 6 months later policy was complete with revisions occurring every couple of years

4. DCD today 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

5. Challenges 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

6. End of Life Care 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 Healthcare team unwilling/unable to offer different plan of care

7. Knowledge of DCD process 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

8. Controlled vs Uncontrolled DCD Controlled DCD equals time to make decision Death is anticipated Withdrawal of care is planned Uncontrolled DCD equals compressed decision time Frequently in ED/trauma Planning is minimal

9. Ethical Principles 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

10. Our Responsibility 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

11. Questions? margie.whittaker@stjoe.org