Volume 198 - Issue 2
Single-centre experience of donation after cardiac death
Authors: Tim G Coulson and David Pilcher
Med J Aust 2013; 198 (2): 88. || doi: 10.5694/mja12.11470
Published online: 4 February 2013
Published online: 4 February 2013
In reply: The Alfred Hospital’s donation after cardiac death (DCD) program was developed in full knowledge of ethical concerns such as those raised by Kennedy and Kennedy. All are covered under “DCD guideline development and implementation” in the methods section of our article.1 Specifically, no patient was denied a chance of survival, because all would have undergone withdrawal of cardiorespiratory support even if donation were ...
In reply: The Alfred Hospital’s donation after cardiac death (DCD) program was developed in full knowledge of ethical concerns such as those raised by Kennedy and Kennedy. All are covered under “DCD guideline development and implementation” in the methods section of our article.1 Specifically, no patient was denied a chance of survival, because all would have undergone withdrawal of cardiorespiratory support even if donation were not considered.
The mistaken inference of Kennedy and Kennedy’s statement “The procedure failed . . .” is that the aim is to withdraw cardiorespiratory support in such a way as to achieve organ donation. Although the timing of withdrawal of cardiorespiratory support may be influenced by organ donation, the decision to withdraw cardiorespiratory support is taken independently.
The use of external opinions on prognosis, not organ donation, and two intensive care specialists (one to manage withdrawal, one to advise about donation) ensures separation of the decisions about palliative care from organ donation.
We thank Kumar and colleagues for their comments and note their recent article where they describe similar experiences to ours. The case highlighted in our paper where a patient who was initially considered for DCD returned to reasonable functional status, highlights the need for careful, thorough and transparent processes about determining prognosis in critically ill patients, and that these should be independent of any decision about organ donation. The fact that an independent prognostic opinion led to continuation of active therapy demonstrates the safety inherent in the Alfred Hospital’s program.
We agree that DCD has not reduced the number of organ donations after brain death and has the potential to expand the donor pool.
Competing interests
David Pilcher is a Medical Advisor to DonateLife in Victoria.
References
- Coulson TG, Pilcher DV, Graham SM, et al. Single-centre experience of donation after cardiac death. Med J Aust 2012; 197: 166-169. 0_GAFHJHIA