[newohiorn]

Originally Posted by kindaquazie

Hi,

We do this procedure at my hospital and it is very difficult and very rewarding. The process is usually initiated by the family members. For instance, there is no hope for Jane Doe to ever recover and she needs agressive life support. However, she did not advance to brain death for a variety of reasons. The family has decided to withdraw support, and the patient will likely die within minutes as she is requiring ventilatory support and pressors. However, she is not brain dead and therefore cannot be an organ donor as she had wished. The family is devestated. But, there is a ray of hope to bring meaning to the death of this young girl, DCD. The family is grateful, the organs are donated, and several other people get to lead much better lives.

Each case should be followed by a debriefing for those involved. Each case is extremely individual. But for families, it is a blessing. Can you imagine praying one day for your son to live, and the next that his brain will herniate so he can be an organ donor. This gives families a real sense of meaning when it is time to withdraw support.

This is also done at my hospital just as kindaquazie described. I don't have a problem with it and would want my family to do this if I weren't technically brain-dead.

[jtrauma]

Brain dead is brain dead, there is not hearing there is no feeling of pain, the brain is not receiving blood flow or oxygen so therefore those sensory functions are lost. So why you would give morphine to a brain dead patient is beyond my comprehension because the body is feeling nothing.

DCD (Donor after Cardiac Death) is, I think, a very important part of saving peoples lives. A family has decided to withdrawl care and take away ventilatory support but wants to help others and the patient would want the same. This is something we consider and do a lot in the hospital I work in and it is very rewarding for everyone. The family get to stay at the bedside after care has been withdrawn and be there with their family member as he/she passes. If he/she does not pass in, if I remember, 30 minutes then the donor process is ceased and they are transferred to a private room to pass. If they do pass within that 30 minutes then the family is allowed to say goodbye and the patient is taking to the OR. To me this is no different then just letting someone pass after withdrawling care and checking for heart tones as we do all the time its just that in this case the patient is able to provide for others.

Julia

[judytheoldrn]

Sorry, I wasn't suggesting we give MS to brain dead pts, I was saying that I have less of a problem with DCD than when docs order high doses of MS on NON-brain dead, non organ donor patients to "hurry them along." Wonder how they would feel if they were the ones with the syringe in hand? But that's another thread, didn't mean to hijack this one!

[subee]

Originally Posted by judytheoldrn

Sorry, I wasn't suggesting we give MS to brain dead pts, I was saying that I have less of a problem with DCD than when docs order high doses of MS on NON-brain dead, non organ donor patients to "hurry them along." Wonder how they would feel if they were the ones with the syringe in hand? But that's another thread, didn't mean to hijack this one!

Oh please do "hurry me along". I don't want my children's generation to pay for futile care, nor do I want to keep my family at the bedside one minute longer than necessary. Morphine is God's gift and should be used wisely. For me, this would be a wise use. I don't want to linger. Any extra time spent hovering around the inevitable is time better spent on other patients who have a chance to leave the hospital fairly intact.

[jtrauma]

I'm totally all for giving MS to make the passing more "hurried". I agree it keeps the patient from suffering more than necessary the family as well, I would think watching someone die for days is a lot more torterous than watching them for a couple of hours and they are comfortable.

[TulsaTime]

We just recently did the first DCD at our hospital. Our unit has a very very high number of donors as we are a neurosurgical/trauma unit & in one month we had 10 donors, one of which was DCD. It was very complicated, initiated by the family, and very rewarding to accomplish. Our OR is 4 floors below us so we withdrew support in the OR and the patient died there. I personally see it as an excellent alternative to families who wish to donate but their family member does not progress to brain death. We all worked extremely hard on that patient and just recieved a letter that 10 people benefited from the recovery!

[moonshadeau]

I just wanted to point out that before we had "brain death" criteria, the original donation for transplantation came from cadaver organs from the 1960'ish, or non-beating heart donation. DCD came back into favor because of the limited supply of organs. DCD has been a great way to enable a family that wants to "gift" organs that would otherwise be unable if they had to wait for brain death to occur (which is terribly grueling for families who sit and wait to have it confirmed that yes, their loved one is truly gone).

We take our patients into the OR as a planned procedure. We extubate the patient having the MSO4 in hand in case they happen to struggle for air, it is not an excessive amount. The family is able to be with the patient in the OR right up until the family is ready to leave and the gifting begins. If the patient does not die within two hours, the patient is transferred back to the critical care unit and then pallative care begins.

Families have been very grateful for the process. We even had one family that had a trauma patient who did not qualify for BDC, but wanted to donate so badly that they transferred their loved one to another hospital that did the DCD (before we had our policy in place).

[JW-RN]

Originally Posted by moonshadeau

I just wanted to point out that before we had "brain death" criteria, the original donation for transplantation came from cadaver organs from the 1960'ish, or non-beating heart donation. DCD came back into favor because of the limited supply of organs. DCD has been a great way to enable a family that wants to "gift" organs that would otherwise be unable if they had to wait for brain death to occur (which is terribly grueling for families who sit and wait to have it confirmed that yes, their loved one is truly gone).

We take our patients into the OR as a planned procedure. We extubate the patient having the MSO4 in hand in case they happen to struggle for air, it is not an excessive amount. The family is able to be with the patient in the OR right up until the family is ready to leave and the gifting begins. If the patient does not die within two hours, the patient is transferred back to the critical care unit and then pallative care begins.

Families have been very grateful for the process. We even had one family that had a trauma patient who did not qualify for BDC, but wanted to donate so badly that they transferred their loved one to another hospital that did the DCD (before we had our policy in place).

this is almost EXACTLY how our policy reads...

I sit on the Organ Donation Committee of our health system (as the NSICU rep) and can tell you that shaping this policy was VERY difficult and it can be even more difficult to execute, but it is definitely worth it!

[MadJackie]

For a few years now, the UK has been performing non-heart organ donation (NHBOD), and I fully support it. I really cannot see the problem with it. The procedure is obviously not the same as "routine" organ donation (heart beating) as the patient has to be certified brain-stem dead for this. Whereas for NHBOD, the patient is still going to die, and the situation is hopeless, BUT the patient does not fit the criteria for being brain-stem dead.
Many of our relatives approach us regarding organ donation, but prior to NHBOD, many relatives were left feeling frustrated because they couldn't give this wonderful gift as their relative didn't fit the criteria.

The UK Translant Team are independent and play no part in the decision-making process of the patients treatment withdrawl. They are only contacted after decisions have been made.

There are thousands of people waiting for organs, and if I am dead or if someone I love dies, the organs are no longer needed. I know it would make me feel a little better if I knew the organs of my loved ones are "living on" in someone else. Or mine are living in someone else after my death.

It's the free gift of life.