Donation After Brain Death vs. Donation After Cardiac Death
Donation After Brain Death (DBD) / Donation After Cardiac Death (DCD)
Injury / Severe brain injury from trauma, cerebral vascular accident, anoxic event, other – REFERRAL TO OPO / Severe brain injury from trauma, cerebral vascular accident, anoxic event, other - REFERRAL TO OPO
Meets Criteria for Brain Death / Yes–
Clinical Exam (including apnea test) is consistent with Brain Death. If unable to fully complete any part of the clinical exam, a confirmatory test is required (ie: Nuclear Flow Scan). / No –
some neurological reflex is still present
Prognosis / Brain death – this is the Legal Time of Death / Hospital physician determines patient has no chance of recovery; cannot survive without mechanical ventilator.
Action / Brain death declaration is made by Hospital Physician (not OPO).
Signed brain death note and consent form are faxed to OPO.
Once BD is declared, OPO and Hospital work cooperatively on medical management of the donor patient. Orders come from OPO.
Patient remains on ventilator throughout organ recovery.
  • Anesthesiology is present for intra-operative fluid and BP management
Transplant team spends 3-4 hours recovering organs / Family/NOKelects to withdraw support
Donation discussion with family – they consent.
Physicianfutility note, family signed WI consent and hospital surgical consent faxed to OPO
OPO/Hospital work on management of the donor pt. Orders signed by hospital physician (no death declaration yet, so OPO offers guidelines, but can’t sign).
Withdrawal of support can take place inOR or ICU
  • RT with a portable vent is used for OR w/d
  • ICU nurse to OR to administer medsfor w/d and assist family if they choose to come to OR
Cardiac Death
  • No BP, pulse, cardiac sounds or respirations
Family leaves /recovery team waits 5 minutes to ensure no auto-resuscitation.
After 5 minutes of ceasedcirculation, Hospital Physician (not OPO) declares death.
Transplant team begins rapid recovery; takes 1-2 hours
Possible Organs /
  • Heart, lungs, liver, pancreas, kidneys, and intestine
/
  • Lungs, liver, pancreas, and kidneys

Key Points /
  • The time of brain death is legal time of death
  • Brain death is not a coma, it’s irreversible – brain cells do not recover
  • Organs dissected in-situ
  • Maintained on ventilator throughout the organ recovery
/
  • DCD is only discussed with families after decisionto withdraw care has been made
  • Rapid recovery of organs
  • If patient does not expire within 2 hours, organ donation is no longer possible, and the patient is returned to the unit. He/she is not re-intubated. RN to call with CTOD to page Tissue/Eye agencies.

Make the Golden Hour Call
UW Health - Organ Procurement Organization
1-866-UWHC OPO
1-866-894-2676

Refer all deaths and imminent deaths regardless of age or diagnosis within one hour
Clinical triggers to call :
A mechanically ventilated patient with a severe neurologic injury or insult and one of the following:
  • A patient whom a physician is evaluating for brain death
OR
  • A patient with a Glasgow Coma Score (GCS) of 5 or Less
OR
  • A plan to discuss withdrawal of life sustaining therapies
Timely notification is defined as referral to the OPO within one (1) hour of patient meeting the criteria for clinical triggers as defined above. /
Time from recovery to transplantation:
Heart: 4-6 hours
Lungs: 4-6 hours
Liver: 12 hours
Pancreas: 12-18 hours
Kidneys: up to 48 hours
Small Intestines: 4-6 hours
Tissues: up to 5 years
Corneas: up to 7 days
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