demystify the process and to address legitimate concerns. The overall message is that implementing DCDD protocols will offer many more individuals the opportunity to donate organs at the end of their lives. This conceptual integration of end-of-life care and organ recovery in DCDD cases will help create a more rational comprehensive clinical approach to patient and family care in these difficult circumstances (Chapter 4).
Ensure the opportunity for donation. Steps can to be taken to increase opportunities for DCDD. Professional societies, such as the American Heart Association, should add steps for preparation for such donations to the end of their standard resuscitation protocols. This would prompt emergency services personnel to take various actions, such as administer organ preservation medications or search for documentation of the individual wishes (e.g., a driver’s license). Furthermore, it will be important to develop standards by which organ preservation measures (such as cannulation) for DCDD can be taken. Registration with an organ donor registry or other forms of donor consent (an organ donor card or a driver’s license) should be considered as the necessary documentation for beginning appropriate medical processes for organ donation after death. In cases of death without that documentation, organ preservation methods could be started to allow the family the opportunity to donate their loved one’s organs if they choose to do so.
Mentor and evaluate. Current variations among hospitals and OPOs in the number of DCDD cases need to be addressed through mentoring programs and other efforts by the Organ Donation Breakthrough Collaboratives and professional organizations, which should encourage the development of DCDD programs. As programs are being evaluated, it is important that potential DCDD donors be considered part of the denominator in all measures used to evaluate actual conversion rates.
Clarify regulatory and statutory requirements. Because preservation efforts to maintain the viability of the organs must be initiated soon after circulatory determination of death to preserve the opportunity for organ donation, statutory criteria for the determination of death by either neurologic or circulatory criteria should be clearly specified. Furthermore, the regulation requiring Medicare-funded hospitals to refer all deaths and imminent deaths to an OPO (ACOT, 2005) must be strengthened and expanded to encompass imminent circulatory-related deaths. Despite this requirement, many referrals are being made after the patient has been declared dead by neurologic criteria, cardiopulmonary resuscitation has been stopped, mechanical support has been withdrawn, or the decision has been made to withdraw support. These late referrals are much less likely to result in successful organ donation. In fact, premature removal of mechanical support can be a major barrier to organ donation.