BOX 5-2

Common Criteria for Termination of Advanced Cardiac Life-Support Efforts

Termination of advanced cardiac life-support efforts occurs if there is no response after the following interventions have been performed:

  • Acceptable basic cardiopulmonary resuscitation has been provided.

  • Ventricular fibrillation has been eliminated.

  • An advanced airway device has successfully been placed.

  • The operation of the airway device has been confirmed and the device has been secured.

  • Oxygen and end-tidal carbon dioxide levels have been monitored to ensure that proper oxygenation and ventilation have been achieved.

  • The intervention has been maintained for 10 minutes or longer.

  • All rhythm-appropriate drugs have been administered.

SOURCE: Kern et al. (2001).

For cases of controlled DCDD, measures for preservation and recovery may include the administration of medications to improve organ viability, including heparin, or the use of intravenous cannulation or cardiopulmonary assist devices (bypass procedures). After organ removal, pulsatile perfusion may be used for the kidneys to help determine if the patient’s organs will be eligible for transplantation. For cases of cardiac arrest in uncontrolled circumstances, there is not time to plan in advance to maintain organ viability, but certain organ preservation measures can be implemented after death is declared.

The outcomes of controlled DCDD transplantation have been found to be similar to those for DNDD transplantation for most organs. The University of Wisconsin has performed DCDD transplantations since 1974, with DCDD donors making up 10 to 15 percent of the total donations annually (Lewis et al., 2003). Researchers at that university reported on 568 organs transplanted from DCDD donors between 1984 and 2003 and found that the patient and graft survival rates for patients receiving kidney, pancreas, and lung transplants were similar for organs from DCDD and DNDD donors (D’Alessandro et al., 2004). Delayed graft function has been found to be higher in kidneys transplanted from DCDD donors, but long-term graft survival is similar to DNDD organs (Weber et al., 2002; Droupy et al., 2003; Cooper et al., 2004; D’Alessandro et al., 2004). Researchers have found that the liver is more susceptible to warm ischemic injury (Abt et al., 2004; Foley et al., 2005).

Much remains to be learned about methods to improve organ viability and to preserve organs recovered through both DCDD and DNDD. Re-

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