Actually, everybody on an organ transplant waiting list is waiting for a deceased donor. It is the kind or deceased donor that may be different. Just like I talked about it, there is the brain death donor. Remember that a brain dead patient is legally dead even though the heart is still beating. It happens that a potential organ donor does not meet the criteria of brain death despite suffering irreversible major brain injury. The organs cannot be used or planned to be used until the patient is legally dead. This is where Donation after Cardiac Death (DCD) comes into play. It has been done for the first time in the 1950’s but has routinely been explored as an option since the early 90’s.
Here is how DCD works. You have a patient, a potential organ donor, who has extensive brain injury. The family is talking about life support withdrawal (removing breathing machine that keeps patients alive) but the patient did not meet the criteria of brain death. The family can now be approached by a well trained organ procurement organization representative to discuss organ donation. If the family consents to DCD donation, medical management continues to keep the patient alive so the organs can be matched with transplant candidate. Once organ transplant recipients are matched with the donor’s organs, which can take several hours to achieve, the most crucial part of the whole process begins. Depending on policies in different regions of the United States, the patient is now brought to the operating room or can stay in the intensive care unit.
The life support is then withdrawn (breathing tube removed, medication stopped) and medical staff is standing by waiting for the heart to stop. Once that happens and they need to wait 5 minutes before they can do anything else. The heart needs to be stopped with no blood pressure for 5 minutes. A physician unrelated to the organ donation process declares the patient dead along with the official date and time. After those 5 minutes and patient is pronounced, they are rushing to resuscitate the donor and to put him back on the breathing machine. During all that time, transplant teams have been standing by at the hospital ready to recover the organs.
What happens if the patient does not die? Usually guidelines are strict and if the patient has not passed within the timeframe allowed, 1 or 2 hours depending on policy, the patient is sent back to the nursing floor and the transplant process aborts. Everybody goes home empty-handed.
For someone to receive an organ from a DCD donor, they need to be specially consented for donation after cardiac death. It may not be every transplant center that is comfortable with that so some may not be offering the option to their patients. Basically the patient waiting for organ transplant consenting for donation after cardiac death is giving himself more chance to get a transplant since it increases the donor pool. For the last few years, there was an average of 3 to 5% of donation coming from DCD donor. That number seems to be increasing every year. Some regions are more aggressive at pursuing DCD donor where others are more passive.