Donation After Cardiac Death
PREREQUISITE NURSING KNOWLEDGE
• Knowledge is needed of federal rules, state laws, organ procurement organization (OPO) policies, and hospital policies regarding donation after cardiac death. In 2007, The Joint Commission required hospitals, in coordination with the OPO, to create either donation after cardiac death (DCD) policies or justifications for opting out.2,3
• DCD occurs after irreversible cessation of cardiopulmonary function (see Procedure135).
A patient is ventilator-dependent, and not brain dead, and decisions have been made to withdraw mechanical ventilation.
• Families of patients considered for donation after cardiac death are dealing only secondarily with the request for organ donation. First, these families are dealing with the severe injury or illness of the patient that may have occurred suddenly.
• The decision to cease prolonged measures, including mechanical ventilation, must occur before the discussion about donation after cardiac death.
• The healthcare team that has cared for the potential donor must continue to care for the patient until cardiopulmonary death is pronounced.
• Palliative care is the treatment goal of the potential donor until death is pronounced. A palliative care consultant, if available, may participate in the predeath processes.4
• Palliative care continues if the donation is aborted for any reason after ventilation is withdrawn (e.g., the patient’s death does not follow rapidly after ventilator withdrawal).
PATIENT AND FAMILY EDUCATION
• Inform the family of the patient’s current condition. 
Rationale: The family is kept informed and is prepared for realistic expectations about the patient’s expected outcome.
• Explain the medical and nursing care provided to the patient. 
Rationale: The family understands therapies provided to treat and support the patient.
