will be made and that organ donation will be considered only in the event of a loss of life after every appropriate measure has been attempted.

Furthermore, it is incumbent on the healthcare system to commit the resources needed for implementation of DCDD protocols. It is acknowledged that deaths due to cardiac arrest occur at all hours and that there is often a more time-sensitive urgency with DCDD cases as compared with DNDD. Healthcare systems that are already heavily stressed and thinly stretched may be resistant to changes that will impose additional demands, albeit for lifesaving reasons (Chapter 4).

The committee has identified several actions that are needed to increase the rates of DCDD and offers a proposal to fully evaluate the potential for uncontrolled DCDD. These are outlined below.

  • Provide excellent emergency and resuscitative care. The first and foremost action in implementing a DCDD program is the use of excellent emergency and resuscitative care. State-of-the-art guidelines must be followed, and all efforts should be made to ensure that the patient has every opportunity for survival. The priority is to focus all possible medical care on the individual’s survival.

  • Provide public education. An informed public can make the assessments that are needed to provide input into the planning and development of DCDD protocols. As with the development of the Washington Hospital Center’s uncontrolled DCDD program (described earlier), a transparent and open process is essential, as is the substantive and ongoing involvement of the community in the planning, development, and implementation of a DCDD program. Because deaths due to cardiac arrest occur more frequently than the types of deaths that are determined by neurologic criteria, the general public is probably familiar with what it means to ascertain whether cardiac and pulmonary functions have permanently ceased and is likely to understand, and to be receptive to, public education messages regarding the conditions necessary to facilitate organ donation in that event. Uncontrolled DCDD is admittedly a complex issue, but given the potential for a dramatic increase in the number of available organs for transplantation the committee believes that high priority should be given to these public education efforts as an essential component of an aggressive effort to implement uncontrolled DCDD protocols.

  • Provide professional education. For healthcare professionals, it is particularly important to sponsor educational efforts clarifying the elements of high-quality end-of-life care and explaining the steps and protocols needed to implement DCDD in all settings. Support for DCDD is particularly needed from professional associations. Additionally, the urgent need to implement DCDD protocols should be thoroughly discussed in continuing education and other professional education settings in order to

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