Organ donation after circulatory death (DCD) is one of the two ways by which a person can donate organs and tissues after death.
In Australia the law which allows deceased organ and tissue donation says that a person has died where brain function or circulation of blood in that person’s body has permanently stopped.
In DCD, organ donation occurs after death where the circulation of blood has permanently stopped.
Potential DCD donors are patients in the Intensive Care Unit (ICU) who are so sick that their doctors do not think they have any chance of survival without ongoing artificial ventilation and/or other life support. For these patients to be considered for DCD it is also expected that they will not survive for longer than an hour to an hour and a half when the life supports are withdrawn. Generally they are patients with very severe brain injury from which they cannot recover. Less often, they are patients with terminal heart or lung failure, or have suffered a very severe spinal injury where they cannot breathe unassisted.
Potential DCD donors are generally too sick to make their own decisions. DCD is only considered after agreement has been reached between the treating doctors and the family that continued use oflife-support for this dying patient is no longer in their best interest and shouldbe withdrawn. Once it has been decided that life support will be withdrawn, DCD will then be discussed with the family. Where it is known that a person wanted to donate their organs after death and/or the family authorise this then DCD can proceed.
After family consent for organ donation has been given, arrangements are made for the patient's life support to be withdrawn. This happens either in the Intensive Care Unit or preferably in the Operating Theatre. Palliative care for the patient is provided after life support is withdrawn to keep them as comfortable as possible until death occurs.
During the dying process the patient’s blood pressure drops. Long periods of low blood pressure can damage organs due to lack of blood flow. For this reason, organ donation can only go ahead if the patient dies within 90 minutes after withdrawal of life support organ donation can go ahead.
Once the heart and circulation stop, 5 minutes must lapse in order to establish that the circulation has permanently stopped and death can be declared.
After death essential documents related to death certification are completed; a short time is allowed for family good byes; the patient is transferred to Operating Theatre if they died in Intensive Care and onto the operating table; and surgery commences. It is important that all these things happen as quickly as possible - within a few minutes - to minimise damage to organs due to lack of blood flow. If they are too damaged, the organs may not work properly after they are transplanted.
Following recent advances, hearts removed from DCD donors may be used for transplantation provided the death of the donor is declared consistent with the law in NSW, as described above.
It may seem impossible that the circulation can permanently stop in one person but then the heart can be used for transplant in another. This is because the person’s death after withdrawal of life support is not due to injury or damage to their heart. The person has died after withdrawal of life support because of another problem such as a severe brain injury.
DCD offers the opportunity to provide more hearts along with all of the other organs for people who need transplants.