title: Palliative care consultation in the process of organ donation after cardiac death.
abstract: Palliative care consultation has been demonstrated to be useful in many situations in which expert symptom management, communication around sensitive issues, and family support may serve to enhance or improve care. The process of organ donation is an example of this concept, specifically the process of donation after cardiac death (DCD). DCD allows patients with severe, irreversible brain injuries that do not meet standard criteria for brain death to donate organs when death is declared by cardiopulmonary criteria. The DCD method of donation has been deemed an ethically appropriate means of organ donation and is supported by the organ procurement and medical communities, as well as the public. The palliative care (PC) team can make a significant contribution to the care of the patient and family in the organ donation process. In this paper we describe the controlled DCD process at one institution that utilizes the PC team to provide expert end-of-life care, including comprehensive medical management and family support. PC skills and principles applicable to the DCD process include communication, coordination of care, and skillful ventilator withdrawal. If death occurs within 90 minutes of withdrawal of life support, organs may be successfully recovered for transplantation. If the patient survives longer than 90 minutes, his or her care continues to be provided by the PC team. Palliative care can contribute to standardizing quality end-of-life care practices in the DCD process and provide education for involved personnel. Further experience, research and national discussions will be helpful in refining these practices, to make this difficult and challenging experience as gentle and supportive as possible for the courageous families who participate in this process.
authors.affiliation: Department of Internal Medicine, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA 23298, USA ckelso@vcu.edu
authors.forename: Catherine McVearry
authors.initials: CM
authors.lastname: Kelso
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Lyckholm
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Coyne
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
mesh_terms: D002977:Clergy; D002985:Clinical Protocols; D003142:Communication; D003643:Death; D005066:Euthanasia, Passive; D006801:Humans; D008020:Life Support Care / Q000592:standards; D010166:Palliative Care / Q000592:standards*; D010348:Patient Care Team; D024382:Professional Role; D011368:Professional-Family Relations; D012017:Referral and Consultation / Q000592:standards*; D013727:Terminal Care / Q000592:standards; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000592:standards