title: Consent for donation after cardiac death: a survey of organ procurement organizations.
abstract: BACKGROUND
  Despite the increasing number of policies governing organ donation after cardiac death (DCD), nothing is presently known about the informed consent process for DCD. Without guidelines, organ procurement organizations (OPOs) are likely to structure the consent process similarly to that for organ donation after brain death (DBD), despite important ethical differences between the 2 modes of organ recovery.
  
  
  OBJECTIVE
  To describe informed consent practices used by OPOs for DCD.
  
  
  METHODS
  Cross-sectional, internet-based survey of the 58 OPOs in the United States.
  
  
  METHODS
  OPO policies and reported levels of physician participation in the consent process for DCD.
  
  
  RESULTS
  Seventeen OPOs completed the survey (29%). Responders and nonresponders did not differ by DCD volume over the last year or last 5 years. None of the OPO's policies require physician involvement in obtaining written informed consent; 94% of policies require only the OPO representative to obtain written consent for DCD and 6% state that either the OPO representative or the treating physician may obtain consent; 71% of OPOs reported that discussions with family regarding DCD occur with the treating physician present less than 51% of the time and 82% indicated that the OPO representative is solely involved in obtaining consent for DCD in the majority of cases. A total of 24% of OPOs require physicians to participate in obtaining consent for procedures performed prior to death exclusively for organ preservation. No differences were found between the OPO consent practices for DCD and DBD.
  
  
  CONCLUSIONS
  None of the OPOs responding to this survey have a policy requirement for physician involvement in obtaining consent for DCD. These findings raise questions about the role of physicians in DCD and how best to maintain a patient- and family-centered focus on care for patients at the end of life while supporting organ recovery efforts.
authors.affiliation: Center for Bioethics, Columbia University College of Physicians and Surgeons, New York, NY, USA. kjkalkbrenner@gmail.com
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Kalkbrenner
authors.forename: George E
authors.initials: GE
authors.lastname: Hardart
mesh_terms: D001926:Brain Death / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003643:Death; D006306:Health Surveys; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D009926:Organ Preservation; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000592:standards; D014481:United States