Organ donation: cardiac death v. brain death

JenniferSews · May 4, 2011

I only know organ donation through my husband and his job. But I have a big interest in it so have learned a lot. From his perspective in DNA matching, cardiac death donations were less desirable by the recipient.

Think about it like this, the brain still functioning on a basic level will still send out the signals to perfuse the vital organs until the very end. But the heart, in a state of slow decline, will only purfuse the most vital organs. In a trauma incident it will perfuse the heart and the brain, leaving the kidneys, pancreas, liver and other organs. A kidney or other organ transplanted after cardiac death is potentially in poorer condition than one after brain death. Obviosly this is the bare basics.

But for your question ultimately the faster you can harvest those organs, the lesser the potential damage. You can help by preparing the family of the donor so they are ready to cope with such a difficult situation as best they can. Hope that helps. My 3 year old is crawling all over my so it's hard to put my thoughts together.

core0 · May 5, 2011

I have done many transplants involving pts whose families have been educated, informed about, and consented to organ donation resulting from "brain death". I recently had the experience of dealing with a pt and family faced with the dilemma of whether or not to consent to organ donation as a result of "cardiac death".
This issue has not been touched on very often in my experience. I am having a hard time specifically in dealing with organ donation from cardiac death. Please excuse me if I do not relay my understanding with accuracy...which is why I am asking you guys if you have dealt with organ donation resulting from cardiac death.
The organ procurement folks called me to tell me that I should have an open room for them to perform an organ retrieval for a pt that was likely going to die from heart failure. The pt had suffered an awful trauma, but was not brain dead. The organ procurement team had not spoken to the family yet regarding donation. They planned to do so after the pt had been pronounced. My dilemma is this: in order for the organs to be viable for retrieval after a cardiac death, the organs must be harvested no more than an hour after death. There is obviously no perfusion to the organs, thus the rationale for a hasty entrance into the OR after the pt is pronounced. This scenario did not sit well with me because it leaves the family in a more than awkward situation. They just lost their loved one, they are now being asked to give consent for organ donation, and the time limit is so small.
I would like to know if any of you have had experience in regards to organ donation and cardiac death. I am having trouble understanding the expected flow of events specifically regarding the family.
Again, I apologize for my confusion, or for any misinformation that I may have relayed as to my limited understanding of this rather delicate situation. Any advice would be appreciated!

Donation after cardiac death is done is cases where the patient does not meet the formal criteria of brain death but there is no chance of recovery. I don't know exactly what the OPO was doing but the donor is not rushed to the OR. Instead the donor is taken to the OR, prepped and draped and then life support is discontinued. If the patient has a non-survivable rhythm (ie cardiac death) for 5 minutes within one hour of discontinuation of life support then death is declared and the procuring team procures the organs. If death does not occur within one hour then the patient is brought back to the ICU and end of life care is started. The management of the patient and pronouncement of death has done by a physician not associated with the transplant.

Here is a powerpoint from Oschner that describes the process and the background:

http://www.lopa.org/Downloads/Donation%20After%20Cardiac%20Death.ppt

CompleteUnknown · May 5, 2011

I have done many transplants involving pts whose families have been educated, informed about, and consented to organ donation resulting from "brain death". I recently had the experience of dealing with a pt and family faced with the dilemma of whether or not to consent to organ donation as a result of "cardiac death".
This issue has not been touched on very often in my experience. I am having a hard time specifically in dealing with organ donation from cardiac death. Please excuse me if I do not relay my understanding with accuracy...which is why I am asking you guys if you have dealt with organ donation resulting from cardiac death.
The organ procurement folks called me to tell me that I should have an open room for them to perform an organ retrieval for a pt that was likely going to die from heart failure. The pt had suffered an awful trauma, but was not brain dead. The organ procurement team had not spoken to the family yet regarding donation. They planned to do so after the pt had been pronounced. My dilemma is this: in order for the organs to be viable for retrieval after a cardiac death, the organs must be harvested no more than an hour after death. There is obviously no perfusion to the organs, thus the rationale for a hasty entrance into the OR after the pt is pronounced. This scenario did not sit well with me because it leaves the family in a more than awkward situation. They just lost their loved one, they are now being asked to give consent for organ donation, and the time limit is so small.
I would like to know if any of you have had experience in regards to organ donation and cardiac death. I am having trouble understanding the expected flow of events specifically regarding the family.
Again, I apologize for my confusion, or for any misinformation that I may have relayed as to my limited understanding of this rather delicate situation. Any advice would be appreciated!

Please forgive me for responding when I know next to nothing about this issue, but I think the part I've bolded is where the problem lies for me. The idea of having everything set up and ready to go before the family are even approached seems so very wrong.

On a personal level, and if I were the spouse, parent, child, partner, etc of a patient with no hope of recovery, the idea of donation after cardiac death somehow sits better with me than donation after brain death, as irrational as that may sound. From what I understand, family are able to stay with the patient until cardiac death occurs and for a few minutes afterwards, not being able to do this is what has always bothered me about donation after brain death.

nrsang97, BSN, RN · May 5, 2011

Donation after cardiac death is done is cases where the patient does not meet the formal criteria of brain death but there is no chance of recovery. I don't know exactly what the OPO was doing but the donor is not rushed to the OR. Instead the donor is taken to the OR, prepped and draped and then life support is discontinued. If the patient has a non-survivable rhythm (ie cardiac death) for 5 minutes within one hour of discontinuation of life support then death is declared and the procuring team procures the organs. If death does not occur within one hour then the patient is brought back to the ICU and end of life care is started. The management of the patient and pronouncement of death has done by a physician not associated with the transplant.
Here is a powerpoint from Oschner that describes the process and the background:
http://www.lopa.org/Downloads/Donation%20After%20Cardiac%20Death.ppt

This has been my experience with the only few I have participated in. I had one family back out, and one that the patient didn't pass in time. We take our patients to PACU and do the extubation there, then to the OR if they do meet DCD criteria.

nrsang97, BSN, RN · May 5, 2011

Patient's family should be approached much sooner than at time of cardiac death. Once it is determined that the patient has a GCS of 5 or less and is vented that triggers the organ procurement agency to be called. They will make the decision of DCD donation vs. brain death donation.

Editorial Team / Admin · May 9, 2011

The way DCDs work at my hospital is that the family is approached before death. I'm not sure when, though. The patient is brought to the OR, prepped, draped, counts are done, and then we use two IV poles with a large drape sheet to hide the instrument table. The surgeon and OR staff step into the substerile room but remain sterile. The family is put into disposable cover suits, shoe covers, hats, masks, and brought back to the OR, where a resident then removes the ETT. The family is allowed to stay until the patient passes, or too much time has passed since removal of the ETT (usually about 1 hour, some will go less and some will go a little longer), and then leaves after the resident pronounces. Five minutes after pronouncement, the surgeons make incision.