How I Manage the Adult Potential Organ Donor: Donation After Cardiac Death (Part 2)

To address the gap between organs available for transplant and the number of patients on the transplant waiting list, the Joint Commission on the Accreditation of Healthcare Organizations, Institute of Medicine, United Network for Organ Sharing and the federal government have recommended the increased used of donation after cardiac death (DCD) (JCAHOnline http://​www.​jointcommission.​org/​Library/​JCAHOnline/​jo_​06.​06.​htm; UNOS, Highlights of the June Board Meeting, 2006). DCD is defined as organ donation once death is declared after irreversible cessation of circulatory and respiratory functions, as opposed to brain death (donation after neurological death). Though DCD is one of the fastest growing categories of organ donors, it comprises only 8% of all deceased donors (Steinbrook in N Engl J Med 357:209–213, 2007). Prior to 1968, when the Ad Hoc Committee of Harvard Medical School proposed a neurological definition of death based on brain-death criteria, organs from deceased donors came from patients who had suffered cardio-pulmonary demise (IOM, Non-heart-beating organ transplantation: practice and protocols, 2000). Early transplantation from DCD donors met with limited success and most transplant surgeons turned to brain-dead donors. Consequently, DCD fell out of vogue and, until recently, has not been the focus of transplant initiatives.