A 43 year-old cyclist is intubated in the ICU after sustaining multiple fractures and brain trauma after being hit by an intoxicated driver. She has multiple skull fractures with bilateral intraparenchymal hemorrhage. Her Glasgow Coma Scale (GCS) remains 2/15 after 2 weeks in the ICU. Her pupils don’t respond to light and she does not withdraw to noxious stimulus but still has EEG activity and some brain stem reflexes; she does not meet brain death criteria. The power of attorney for health care and family reach consensus that she would not want to continue pursuing life-prolonging therapies, and request that all artificial life-support be discontinued. They request that her organs be donated in accordance with her wishes.
Which one of the following statements is True about organ Donation after Cardiac Death (DCD):
a. An representative from the Organ Procurement Office (OPO) may meet with a family to discuss the option of DCD but not participate in any care decisions.
b. DCD is considered unethical unless a patient also meets brain death criteria.
c. Representatives from the organ transplant surgical team must meet with a family/POA and present the options of organ donation vs. no donation at least 24 hours before a planned terminal extubation.
d. The Joint Commission requires involvement of a palliative care specialist in DCD decision making.
The correct answer a.
Organ donation is legally permissible after brain death or cardiac death criteria have been met (Fast Fact #115 for Brain Death Criteria). Aan OPO representative should be contacted prior to death to approach the family about organ donation, and consent the family/patient decision makers for organ donation. However, members of the OPO and organ recovery teams should not participate in patient care decisions or medical care prior to the declaration of death; this policy aims to prevent conflict of interest. There is no mandate to involve specialist palliative care providers in organ donation decisions.
Lustbader D, Goldstein, MJ. Fast Facts and Concepts #242. Organ Donation after Cardiac Death.
