Children’s Hospitals have widely varying policies on organ donation after cardiac death (DCD), according to researchers, who asked 124 hospitals in the United States, Puerto Rico and Canada about their policies in 2007 and 2008.
The study authors received responses from 105 hospitals. They found that 72 percent of them had DCD policies, while policies were being developed in 19 percent, and 7 percent did not have and were not developing policies.
Of the 73 hospitals with DCD policies that were analyzed, 61 (84 percent) specified criteria or tests for declaring death, including electrocardiogram (ECG) findings, no pulse, no breathing, and unresponsiveness. Four policies required total waiting periods prior to organ removal that conflict with professional guidelines: One policy had a waiting period of less than 2 minutes, and three policies had waiting periods of longer than 5 minutes.
The researchers also found that 64 policies (88 percent) didn’t allow transplant personnel to declare death, and 51 percent prohibited them from being involved in premortem (taking place immediately before death) management.
The importance of palliative care was noted in 65 policies (89 percent), but only 7 percent recommended or required palliative care consultation. The use of medications with the intention to hasten death was prohibited in 32 policies (44 percent), the researchers found.
The location of withdrawal of life-sustaining treatment was specified in 68 policies (93 percent), with the majority (54 percent) requiring withdrawal to occur in the operating room. Other locations specified in policies included areas adjacent to the operating room (19 percent), the emergency department (4 percent), or the intensive care unit (4 percent).
“This study demonstrates that, consistent with a national emphasis on increasing the supply of transplantable organs, a large number of children’s hospitals have developed or are developing DCD policies,” wrote Dr. Armand H. Matheny Antommaria, of the University of Utah School of Medicine, in Salt Lake City, and colleagues.
“The policies exhibit notable variation both within those we studied and compared with authoritative reports and statements. Further research will be required to determine the importance of variation in the tests for declaring death or the processes for withdrawing life-sustaining treatment. In the long run, public policy may need to address strategies to promote adherence to recommendations for DCD processes based on sufficient clinical evidence and/or ethical justification,” they concluded.
Source: Journal of the American Medical Association, May 12, 2009
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