Donation After Brain Death Versus Donation After Cardiac Death
UW Hospital and Clinics Organ Procurement Organization publishes the following as a guide describing the difference between organ donation after brain death (DBD) and organ donation after cardiac death (DCD).
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Donation After Brain Death (DBD)
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Donation After Cardiac Death (DCD)
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Injury
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Severe brain injury from trauma, cerebral vascular accident, anoxic event, other – REFERRAL TO OPO
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Severe brain injury from trauma, cerebral vascular accident, anoxic event, other - REFERRAL TO OPO
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Meets Criteria for Brain Death
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Yes: Clinical Exam (including apnea test) is consistent with brain death. If unable to fully complete any part of the clinical exam, a confirmatory test is required (i.e., Nuclear Flow).
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No: Some neurological reflex is still present
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Prognosis
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Brain death: This is the legal time of death
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As determined by hospital physician, patient has no chance of recovery from brain injury; cannot survive without mechanical ventilator.
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Action
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Brain death declaration is made by hospital physician (not OPO).
Signed brain death note and consent form are faxed to OPO.
Once brain death is declared, OPO and Hospital work cooperatively on medical management of the donor patient.
Patient remains on ventilator throughout organ recovery.
Anesthesiology is present for intra-operative fluid and BP management
Transplant team spends three to four hours recovering organs in-situ.
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Family/NOK elects to withdraw support
Donation discussion with family, they consent. Signed futility note and consent form get faxed to OPO.
OPO and hospital work cooperatively on medical management of the donor patient.
Withdrawal of support can take place in OR or ICU
Cardiac death
Wait five minutes to ensure no auto-resuscitation.
After five minutes of ceased circulation, hospital physician (not OPO) declares death. Transplant team immediately begins organ recovery; takes one to two hours to recover organs en-bloc.
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Potential organs
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Heart, lungs, liver, pancreas, kidneys and intestine
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Lungs, liver, pancreas and kidneys
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Key Points
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The time of brain death is legal time of death
Brain death is not a coma, it's irreversible – brain cells do not recover
Organs dissected in-situ
Maintained on ventilator throughout the organ recovery
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DCD is only discussed with families after decision to withdraw support has been made
Rapid recovery of organs procured en-bloc
If patient doesn't expire within two hours, organ donation is no longer possible, and the patient is returned to the sending unit. He/she is not re-intubated. RN to call OPO with CTOD.
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