Variation in donation after circulatory death hospital policies in a single donor service area

Abstract

Background: Historically, there has been wide variation among hospital policies for donation after circulatory death (DCD) processes. With more DCD donors as well as more organs from DCD donors being utilized, it is time to revisit the variability in DCD hospital policies.

Methods: Collection of hospital characteristics, DCD referrals and completions, and DCD policies from the Southwest Transplant Alliance Donor Service Area. Content analysis of DCD hospital policies.

Results: We found variability in referral requirements, discussion elements for authorization, pre-mortem interventions and process elements. Most policies allow prepping and draping (84.7% [83 of 98]) and premortem heparin administration (78.6% [77 or 98]). A minority allow femoral cannulation prior to extubation (19.4% [19 of 98]) or during the hands-off period (15.3% [15 of 98]).

Conclusions: We recommend a national effort to achieve consistency and clarity in DCD hospital policies based on our findings of continued variability in DCD hospital policies.

Keywords: Authorization; Donation after circulatory death; Hospital policy; Organ donation; Pre-mortem interventions.