Donation after Cardiac Death (DCD)

Over the past 40 years organ transplantation has progressed from an experimental technique to a preferred method of treating end stage organ failure. Due to its success, more patients are choosing transplantation as a viable treatment option. Today, more than 95,000 people are on the national waiting list for organs.

In an effort to combat this health crisis, many initiatives have been undertaken, including increased public and professional education, routine referral legislation, the use of organ donors with pre-existing medical conditions, and the increased use of living donors. Despite these efforts, donation has remained relatively static, with organs being recovered from only about 8,000 donors per year in the United States.

Prior to the introduction of brain death laws, DCD was the way in which all organs were recovered for transplant, and was a common practice prior to the 1980s. In fact, in 1967 a DCD recovery led to the donation for the first successful heart transplant. Prior to 2003, DCD was referred to as “non-heart-beating donation (NHBD).” An initiative many organ procurement organizations (OPOs) have undertaken is the re-evaluation of the use of organs donated after cardiac death (DCD). Donation After Cardiac Death (DCD) is an option for families of patients who have a severe neurological injury and/or irreversible brain damage that is incompatible with life but do not deteriorate to brain death.

The increasing gap between the demand for donor organs, and the available supply, is only one consideration when evaluating the recovery of organs from donors after cardiac death. The other is the need to address patient and family wishes by providing additional options at the end of life. With the recent societal changes in health care, physicians frequently discuss the removal of life support with patients and family members when devastating trauma or critical illness strikes. A growing number of individuals now execute advance directives that provide for this removal of life support systems should they become incapacitated.

DCD only becomes an option for families who have already decided that their loved one’s life support should be removed. The recovery of organs from DCD donors should not be viewed as an attempt to circumvent brain death criteria but a means to provide patients and/or families with an additional option of donation that complies with patient or authorized family directives.