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DCD in the neurologically aware

Donation after circulatory death (DCD) typically involves patients who are on a ventilator as the result of devastating, irreversible brain injury and following a decision to withdraw support.

In addition, potential DCD donors could also be patients with high spinal cord injuries or end-stage musculoskeletal disease, in which a decision to withdraw support has been made. Those patients may be neurologically aware and able to authorize their own treatment and donation decisions.

The OPTN/UNOS ethics committee believed it would be of value to address specifically the issue of DCD in the neurologically aware population. Some transplant professionals are reluctant to recover or accept organs from DCD donors who are neurologically aware and who have made a decision to have their ventilator support withdrawn.

The committee wanted to provide a statement to fulfill the need for ethical guidance on the issue, and to support the coordination of DCD in the neurologically aware population in appropriate cases.

When considering a position statement, the ethics committee unanimously determined that DCD in the neurological aware population does not raise any unique ethical issues. The main consideration is that the withdrawal-of- care decision is made in an ethically and clinically appropriate manner and is independent of the decision to donate.

Given that determination, the committee developed a position statement to support the donation and transplantation community in coordinating DCD in the neurologically aware population in appropriate circumstances.

At its meeting on June 24 and 25, the OPTN/UNOS board of directors voted to formally adopt the statement, which reads as follows,

The OPTN/UNOS Board of Directors affirms that DCD in the neurologically aware patient population is ethical and does not raise unique considerations with respect to the ability for individuals who have capacity to provide first person consent for organ donation after death. DCD in neurologically aware patients should be routinely offered in appropriate circumstances when there has been an informed decision to withdraw support.

Appropriate end-of-life care for patients with recent neurological injury requires significant attention to ensure the decision to withdraw support (independent of the decision to donate) is made under ethically and clinically appropriate circumstances. Potential donors in those cases should be informed if the decision to donate will impact the planned end of life care.

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