Community Services

Donation After Cardiac Death

Donation after Cardiac Death (DCD) is another way in which a person can help to save lives through organ donation. It can occur when a patient has a non-survivable, irreversible, severe brain injury but does not meet criteria for the diagnosis of brain death. If the family decides to withdraw the patient from treatment, it may be possible for that person to be an organ, eye and tissue donor. Once consent is obtained from the family, the patient is taken into the operating room where support is withdrawn. In some cases, support is withdrawn in the ICU. Once the heart stops and death is pronounced by a doctor who is not a member of the organ recovery or transplant teams, it may be possible to recover abdominal organs (liver, kidneys, pancreas) for transplant. This like any other surgery is a very delicate and careful procedure. Organ donation can only occur if the death happens rapidly. Once organs have suffered a lack oxygen and blood flow for an extended period of time, they are not suitable for transplant.

DCD has been an end-of-life option for patients and families for more than 30 years. Prior to the introduction of brain death laws, it was the way in which all organs were recovered. Donation after brain death offers better outcomes and the ability to recover the heart, lungs, liver, pancreas, kidneys and intestines however, if a patient’s death is imminent his/her family can decide to help others once the decision to withdraw support has been made. Because of the shortage of organs available for transplantation and improved medications and surgical techniques for DCD, a person can still save lives without the diagnosis of brain death.

View the Donation after Brain Death (DBD) vs. Donation after Cardiac Death (DCD) chart.

The DCD Process

The donation process (DBD or DCD) always observes the needs and wishes of the patient and/or his/her family.

  1. End of Life Decision
    After a patient has been diagnosed with a severe brain injury, the medical team meets with the family to explain their loved one’s condition and prognosis. After exhausting all medical options, the medical team consults with the family regarding their wishes about the decision to withdraw treatment.
  2. Evaluation
    If the family decides to withdraw treatment, a referral is made by the hospital staff to the Organ Procurement Organization (OPO). A staff member from the OPO evaluates the patient to determine if he/she is suitable to be an organ donor.
  3. Consent
    If the OPO staff determines that the patient is a good candidate for organ donation, he/she will meet with the family. Once consent is obtained from the family, further tests will be done to determine organ function and transplant suitability. The OPO staff will coordinate the donation process. Timing of funeral arrangements is also discussed.
  4. Withdrawal of Support
    When the hospital staff and the family are ready, the patient is transferred to the OR. The family is allowed as much time as needed to say goodbye to their loved one and depending on hospital policies, they may be present at the end of life if they wish to do so. Once in the OR, medications are administered for organ viability and comfort care. The patient is then extubated. The hospital staff declares death once patient meets criteria for cardiac death (absence of spontaneous respirations and heart beat). If the patient does not expire within one hour, organ donation is not possible and he/she is transferred back to a room. Generally, this does not mean that the patient will get better but that organ donation is not possible.
  5. Surgical Recovery
    The OPO surgical team waits five minutes after the heart stops beating before the surgery begins. Organs for transplant are then recovered.

Questions about DCD

  • Does the patient suffer pain during organ recovery?

After a patient dies, he or she no longer feels pain. Organ recovery occurs only after a patient is declared dead.

  • Are medical professionals hastening the death of the patients?

Patients considered for DCD have suffered a devastating brain injury. Family members in consultation with the patient’s physician, decide whether treatment should be withdrawn. The decision to withdraw treatment and the decision to donate organs/tissue are independent of one another.

  • Is there conflict of interest for the OPO?

The OPO is contacted when death is imminent or after the determination to withdraw support has been made by the family and physician. The role of the OPO is to educate hospital staff, ensure every family is offered the opportunity to donate and honor the wishes of the patients and their families.