CONTEXT: Although authoritative bodies have promulgated guidelines for donation after cardiac death (DCD) and the Joint Commission requires hospitals to address DCD, little is known about actual hospital policies. OBJECTIVE: To characterize DCD policies in children's hospitals and evaluate variation among policies. DESIGN, SETTING, AND PARTICIPANTS: Mixed-methods analysis of policies collected between November 2007 and January 2008 from hospitals in the United States, Puerto Rico, and Canada in 2 membership categories of the National Association of Children's Hospitals and Related Institutions. MAIN OUTCOME MEASURES: Status of DCD policy development and content of the policies based on coding categories developed in part from authoritative statements. RESULTS: One hundred five of 124 eligible hospitals responded, a response rate of 85%. Seventy-six institutions (72%; 95% confidence interval [CI], 64%-82%) had DCD policies, 20 (19%; 95% CI, 12%-28%) were developing policies; and 7 (7%; 95% CI, 3%-14%) neither had nor were developing policies. We received and analyzed 73 unique, approved policies. Sixty-one policies (84%; 95% CI, 73%-91%) specify criteria or tests for declaring death. Four policies require total waiting periods prior to organ recovery at variance with professional guidelines: 1 less than 2 minutes and 3 longer than 5 minutes. Sixty-four policies (88%; 95% CI, 78%-94%) preclude transplant personnel from declaring death and 37 (51%; 95% CI, 39%-63%) prohibit them from involvement in premortem management. While 65 policies (89%; 95% CI, 80%-95%) indicate the importance of palliative care, only 5 (7%; 95% CI, 2%-15%) recommend or require palliative care consultation. Of 68 policies that indicate where withdrawal of life-sustaining treatment can or should take place, 37 policies (54%; 95% CI, 42%-67%) require it to occur in the operating room and 3 policies (4%; 95% CI, 1%-12%) require it to occur in the intensive care unit. CONCLUSIONS: Most children's hospitals have developed or are developing DCD policies. There is, however, considerable variation among policies.
CONTEXT: Although authoritative bodies have promulgated guidelines for donation after cardiac death (DCD) and the Joint Commission requires hospitals to address DCD, little is known about actual hospital policies. OBJECTIVE: To characterize DCD policies in children's hospitals and evaluate variation among policies. DESIGN, SETTING, AND PARTICIPANTS: Mixed-methods analysis of policies collected between November 2007 and January 2008 from hospitals in the United States, Puerto Rico, and Canada in 2 membership categories of the National Association of Children's Hospitals and Related Institutions. MAIN OUTCOME MEASURES: Status of DCD policy development and content of the policies based on coding categories developed in part from authoritative statements. RESULTS: One hundred five of 124 eligible hospitals responded, a response rate of 85%. Seventy-six institutions (72%; 95% confidence interval [CI], 64%-82%) had DCD policies, 20 (19%; 95% CI, 12%-28%) were developing policies; and 7 (7%; 95% CI, 3%-14%) neither had nor were developing policies. We received and analyzed 73 unique, approved policies. Sixty-one policies (84%; 95% CI, 73%-91%) specify criteria or tests for declaring death. Four policies require total waiting periods prior to organ recovery at variance with professional guidelines: 1 less than 2 minutes and 3 longer than 5 minutes. Sixty-four policies (88%; 95% CI, 78%-94%) preclude transplant personnel from declaring death and 37 (51%; 95% CI, 39%-63%) prohibit them from involvement in premortem management. While 65 policies (89%; 95% CI, 80%-95%) indicate the importance of palliative care, only 5 (7%; 95% CI, 2%-15%) recommend or require palliative care consultation. Of 68 policies that indicate where withdrawal of life-sustaining treatment can or should take place, 37 policies (54%; 95% CI, 42%-67%) require it to occur in the operating room and 3 policies (4%; 95% CI, 1%-12%) require it to occur in the intensive care unit. CONCLUSIONS: Most children's hospitals have developed or are developing DCD policies. There is, however, considerable variation among policies.
Authors: Ari R Joffe; Joe Carcillo; Natalie Anton; Allan deCaen; Yong Y Han; Michael J Bell; Frank A Maffei; John Sullivan; James Thomas; Gonzalo Garcia-Guerra Journal: Philos Ethics Humanit Med Date: 2011-12-29 Impact factor: 2.464
Authors: Matthew J Weiss; Laura Hornby; Bram Rochwerg; Michael van Manen; Sonny Dhanani; V Ben Sivarajan; Amber Appleby; Mary Bennett; Daniel Buchman; Catherine Farrell; Aviva Goldberg; Rebecca Greenberg; Ram Singh; Thomas A Nakagawa; William Witteman; Jill Barter; Allon Beck; Kevin Coughlin; Alf Conradi; Cynthia Cupido; Rosanne Dawson; Anne Dipchand; Darren Freed; Karen Hornby; Valerie Langlois; Cheryl Mack; Meagan Mahoney; Deepak Manhas; Christopher Tomlinson; Samara Zavalkoff; Sam D Shemie Journal: Pediatr Crit Care Med Date: 2017-11 Impact factor: 3.624