Organ donation after cardiac death (DCD), also known as donation after circulatory death, is the type of donation that was used in the early years of organ donation. Before brain death criteria was established, DCD and living related donation were the only options.
This type of donation occurs when a patient has an illness from which he or she cannot recover, and the patient is being kept alive by artificial means, including ventilators and supportive drugs. The patient is not brain dead, but has no hope of recovery.
Once the family makes the decision to withdraw artificial support, the option to donate organs after cardiac death is presented by representatives of the local organ procurement organization if the patient meets age and medical criteria. The decision to withdraw support is made independently of the decision to donate. That way, if the donation falls through, the family has still made the correct decision for their loved one, without having the possibility of donation as a factor.
Consenting for donation on your driver's license or another donor registry is not consent for the DCD process. That consent is specifically for donation after brain death, which is another type of donation. For a DCD donation, the legal next of kin must consent to the process.
If family is interested in donation, and has made the decision to withdraw support, that process will occur in the operating room instead of the hospital room. The time from the family consenting to the process to the removal of support is typically no less than 8 hours, because of the blood tests and other arrangements that must be made.
Once in the OR, if patient’s heart stops within the designated time frame for donation, the team then waits for several minutes to insure that the heart does not function. At this time, a physician from the hospital, not the organ recovery team, will pronounce the patient dead. Then, the surgery to procure the organs for donation begins. There will be at least 2 minutes between heart beats that circulate blood and making the surgical incision.
While donation after cardiac death increases the number of organs available for transplant, this type of donation does not allow for organs other than the liver and kidneys to be procured in most cases. This is because the heart, lungs, pancreas, and intestine cannot tolerate being without blood flow, even during the short time between the cardiac arrest and the surgical procedure.
There are always exceptions, and in some cases lungs and other organs can be procured, but that is the exception rather than the rule.