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Updated: Jan 24, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Exploring staff perceptions of organ donation after circulatory death
Luke A Milross1, Thomas G O'Donnell2, Tracey K Bucknall3
1Department of Intensive Care, The Alfred Hospital, 55 Commercial Rd, Melbourne VIC, 3004, Australia; School of Medicine, University of Notre Dame Sydney, 160 Oxford St, Darlinghurst NSW, 2010, Australia.
Insights
Donation after circulatory death (DCD) is vital for increasing organ donation rates in Australia. Staff acceptance is high, but concerns about family distress and role conflict exist, often mitigated by supportive environments and protocols.
Area of Science:
- Medical Ethics
- Transplantation Medicine
- Critical Care
Background:
- Solid organ donation rates in Australia are suboptimal.
- Donation after circulatory death (DCD) improves organ donor pool and offers good recipient outcomes.
- Hospital staff resistance can hinder DCD implementation.
Purpose of the Study:
- To understand intensive care staff perceptions of DCD.
- To identify barriers and facilitators to DCD implementation in Australian hospitals.
Main Methods:
- A descriptive exploratory study was conducted with intensive care staff.
- Data collection involved open-ended interviews and scaled Likert questions.
- Thematic analysis was used for qualitative data, and quantitative data were averaged.
Main Results:
- DCD acceptance among staff was high (average 8.8/10), though lower than donation after brain death (10.0/10).
- Key concerns included potential increased family distress and personal role conflict transitioning from life support to DCD advocacy.
- Reliance on supportive work environments, protocol adherence, and rationalization of concerns helped overcome barriers.
Conclusions:
- Supportive leadership in ICUs can minimize institutional resistance to DCD.
- Individual staff concerns regarding DCD warrant further investigation in other centers.
- Further research in resistant centers is needed to promote DCD and expand the donor pool.
Background And Objective:
Solid organ donation remains low in Australia; however, donation after circulatory death (DCD) bolsters rates and is associated with good short- and long-term clinical outcomes among recipients, especially in lung and kidney recipients. However, its reintroduction is met with resistance within hospitals. The aim of the present study was to develop a greater understanding of DCD perceptions among staff involved.
Methods:
This descriptive exploratory study incorporated open-ended and scaled questions with intensive care staff at a public tertiary teaching hospital in Australia. Interviews were digitally recorded and transcribed verbatim before thematic analysis. Quantitative responses were assessed using a 10-point Likert scale.
Results:
Twelve participants were interviewed. Responses to the Likert scale questions were averaged. Donation after brain death was unanimously accepted (average = 10.0), whereas DCD acceptance was lower but remained supported (average = 8.8). Interview responses generated five themes, each containing subthemes. Respondents had concerns with DCD where perceptions existed that DCD would increase family distress, from either timeframes not being met or logistical delays. A second major source of concern stemmed from personal conflict relating to their role. There was difficulty transitioning from primarily sustaining life or facilitating palliation alone to advocating for DCD, especially where there was perceived potential for deviations from standard palliation in analgesia, sedation, and investigations. Overall, concerns were overcome by reliance on a supportive work environment, rationalisation of concerns over time, and reliance on protocols.
Conclusions:
Supportive leadership within the hospital's intensive care unit meant DCD occurred with minimal institutional resistance. However, some individual concerns surrounding DCD were identified. These may be present and amplified in other centres. More study is required in centres where institutional resistance to DCD is identified so that DCD may be further promoted to expand the donor pool.
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