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Published on: August 15, 2022
Variation in donation after circulatory death hospital policies in a single donor service area
Anji E Wall1, Rehma Shabbir2, Sneha Chebrolu3
1Baylor Simmons Transplant Institute, USA.
Insights
Hospital policies for donation after circulatory death (DCD) processes vary widely. A national effort is recommended to standardize DCD protocols for improved organ utilization.
Area of Science:
- Organ transplantation
- Medical policy analysis
- Public health initiatives
Background:
- Historically, significant variability exists in hospital policies governing donation after circulatory death (DCD).
- Increasing utilization of DCD donors and organs necessitates a review of these diverse hospital policies.
Purpose of the Study:
- To analyze the variability in hospital policies for donation after circulatory death (DCD) processes.
- To identify specific areas of divergence in DCD protocols across hospitals.
Main Methods:
- Data collection on hospital characteristics, DCD referrals, completions, and policies within the Southwest Transplant Alliance Donor Service Area.
- Content analysis of existing DCD hospital policies.
Main Results:
- Significant variability observed in DCD referral requirements, authorization discussion elements, pre-mortem interventions, and procedural elements.
- Most policies permit prepping/draping (84.7%) and pre-mortem heparin (78.6%).
- A minority of policies allow femoral cannulation before extubation (19.4%) or during the hands-off period (15.3%).
Conclusions:
- Continued variability in DCD hospital policies was identified.
- A national initiative is recommended to promote consistency and clarity in DCD hospital policies.
Background:
Historically, there has been wide variation among hospital policies for donation after circulatory death (DCD) processes. With more DCD donors as well as more organs from DCD donors being utilized, it is time to revisit the variability in DCD hospital policies.
Methods:
Collection of hospital characteristics, DCD referrals and completions, and DCD policies from the Southwest Transplant Alliance Donor Service Area. Content analysis of DCD hospital policies.
Results:
We found variability in referral requirements, discussion elements for authorization, pre-mortem interventions and process elements. Most policies allow prepping and draping (84.7% [83 of 98]) and premortem heparin administration (78.6% [77 or 98]). A minority allow femoral cannulation prior to extubation (19.4% [19 of 98]) or during the hands-off period (15.3% [15 of 98]).
Conclusions:
We recommend a national effort to achieve consistency and clarity in DCD hospital policies based on our findings of continued variability in DCD hospital policies.
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