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First-Ever Comprehensive Guide to Donation after Circulatory Death (DCD) In Development by The Alliance


An interdisciplinary group of volunteer healthcare experts is collaborating with The Organ Donation and Transplantation Alliance to create a first-of-its-kind comprehensive guide to Donation after Circulatory Death (DCD). The Alliance DCD Educational Resource Guide is in development for hospital patient care teams to be aware of the current general approaches to the potential donor who is not pronounced neurologically deceased, but is unable to survive, in which the patient or the family has made the decision to withdraw life-sustaining treatments.

“The Alliance’s National Donation Leadership Council determined that a DCD Guide was needed to increase the number of DCD organs available for transplantation and to highlight best practices around the country,” says Glenn Matsuki, program consultant for The Alliance who is coordinating the work of the group. A number of organizations have provided volunteer professionals to contribute to the guide and include the American Society of Transplantation (AST), Association of Organ Procurement Organizations (AOPO), American Society of Anesthesiologists (ASA), Association for Surgery of Trauma (AAST), Donate Life America, Neurocritical Care Society, and several organ procurement organizations.

“We are going to put together the most effective national practices based on the knowledge and experience of our contributors and develop this guide for broader learning,” says Matsuki.

Dan Lebovitz, MD, a pediatric intensivist at Akron Children’s Hospital and chair of the DCD Educational Guide Workgroup, says the guide will provide information on a range of topics. “From caring for the patient in the ICU to talking to the patient’s family about the potential for donation, to obtaining consent, to identifying what organs may be transplantable, knowing what labs to evaluate and evaluating the organs, talking to transplant centers, talking with the OR staff to prepare expectations, to OR occurrences as well as plans if the donation is unable to move forward—we’re covering it all,” says Lebovitz.

The Alliance has been meeting regularly with the United Network for Organ Sharing (UNOS) DCD Procurement Collaborative project, which is working with more than half of the nation’s organ procurement organizations. UNOS intends to identify and share effective practices related to procurement of organs from donation after circulatory death (DCD) donors.

The DCD Workgroup has four sub-groups working on various sections of the guide.

  • Group #1 is working on the Preamble/Identification/Referral sections and is led by Susan Mandell, MD, professor of anesthesiology and director of Anesthesia for Abdominal Transplantation at the University of Colorado Hospital;
  • Group #2 is working on the Evaluation/Approach/Donor Management sections and is led by Julius Balogh, MD, assistant professor of Anesthesia and Critical Care Medicine and Medical Director of Cardiovascular ICU at the University of Arkansas for Medical Sciences;
  • Group #3 is working on the Allocation/Operating Room sections and is led by Fady Nasrallah, MD, Trauma/Acute Care Surgery, Surgical Critical Care at Scripps Memorial Hospital;
  • Group #4 is working on the Post-DCD Recovery, Non-Recovery and Organs Transplanted section is led by Clint Hostetler, vice president of Clinical Operations at LifeShare of Oklahoma.

Workgroup members include:

Current plans are for the guide to be available in late 2022; the format will be similar to the Community Hospital Resource Guide, completed in 2019. Additionally, a one-page executive overview of DCD will accompany the guide.

The new DCD guide will be complemented by resources in The Alliance’s Community Resource Toolbox that includes articles and presentations on DCD and a reference resource of Online Terminology and Data References.  Additionally, The Alliance offers online DCD educational programs, including a Conversation Series, “Donation after Circulatory Death in Heart Transplant:  The Case for Normothermic Regional Perfusion” on March 15 and On-Demand Advancement Series Programs, “DCD in Pediatrics:  Expanding the Donor Pool Through Kidney & Liver Utilization” and “A Tale of Two Centers:  Expanding the Donor Pool Through the Use of DCD Hearts.”

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