The Alliance

Spotlight Series

The executive insight series is designed for healthcare senior executives. These brief, bi-annual issues focus on topics relevant to top-tier hospital leadership. For each topic, you can find related references, resources, and tools.

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Medical Technology Concept. Beating Heart. Cardiology. Health
It is estimated that DCDD heart recoveries has the potential to expand the donor pool by up to 30%, ultimately decreasing wait times and waitlist deaths.

Making Medical History: DCDD Heart Recoveries

In the past, Donation after Neurological Determination of Death (Brain Death) was the only way to facilitate a heart recovery for the purpose of transplantation. However, recent innovations have made it possible to recover hearts by way of Donation after Circulatory Determination of Death (DCDD). It is estimated that DCDD heart recoveries has the potential to expand the donor pool by up to 30%, ultimately decreasing wait times and waitlist deaths. 

Review of the Basics

The current DCDD approach consists of a 1-2 hour waiting period. Once cardiac arrest and declaration of death takes place, procurement is rushed in order to achieve the following goals:  

  • Control the pace that organs are accessed and recovered 
  • Recreate homeostasis for all organs, not just the heart
  • Extend the time frame for organs to be assessed
  • Expand organ utilization 

Facilitating DCDD Heart Recovery: Cardiopulmonary Bypass Method

Normothermic Regional Perfusion is utilized to isolate the body below the brain and to restore warm, oxygenated perfusion to all organs. There are two options for this process, both with differing benefits and drawbacks. 

Currently in the United States, the most common method of Normothermic Regional Perfusion for DCDD heart recoveries is ECMO, however, the Cardiopulmonary Bypass method is slowly being adopted by transplant surgeons throughout the country. This method involves the following steps:

  1. Traditional DCDD Approach (Recovery team remains out of the room until pronouncement takes place and the hands-off period is observed)
  2. Initiate Cardiopulmonary Bypass 
  3. Organs are Dissected
  4. Wean Off the Bypass (just like in a standard heart procedure) 
    • Allow the heart to start on its own 
    • Observe heart function and blood circulation 
    • Donor is reintubated to provide oxygen to the blood

Considerations for Transplant Coordinators

Unchanged Practices

    • Securing Authorization
    • Donor Management: maintaining hemodynamic stability
    • Securing Nurse to Administer Comfort Measures
    • Securing Pronouncing Physician
    • Frequent Huddles to Review Process
    • Preparation of the Family Regarding Withdrawal

Foreseeable Changes:

  • Authorization Paperwork: may need to include additional components such as potential patient transfers, adjusted wait times, etc.
  • Coordination with Cardiothoracic Team at Transplant Center
  • Overall OR Recoevry Process (i.e. monitoring new time windows, reintubation of donor, etc.)

Ethical Considerations of DCDD Heart Recovery

If we use circulatory determination of death but then restart the heart in a new recipient, does this undermine the fact that we declared the person dead? Under the Uniform Determination of Death Act (UDDA), death refers to the irreversible cessation of circulatory and respiratory functions. This sets a high bar since few would be considered legally dead as technology has advanced to a point where some circulatory function can be restored. In the case of DCDD, we must find that the heart will not restart on its own as we have exhausted the hands-off period and we will not attempt to restart it because it will not lead to any benefit.

The content of this issue is based on a webinar presentation by Andrew S. Mullins, MBA, FACHE (Chief Operating Officer, Lifeline of Ohio), Jessica Demchak, BSN, RN, CPTC (Asst. Director Clinical & Transplant Center Relations, LiveOnNY), Amy L. Friedman, MD, FACS (Executive Vice President, Chief Medical Officer, LiveOnNY). A special thanks to Andrew, Jessica, and Dr. Friedman for their contributions to this in-service.

A Special Thanks to This Series’ Contributors

Amy Friedman Web.2e16d0ba.fill 600x800
Amy L. Friedman
Executive Vice President/Chief Medical Officer
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Jessica Demchak
Asst. Director Clinical and Transplant Center
Deanna Fenton
About the Editor |
Deanna Fenton

Deanna is a knowledgeable and versatile professional with diverse experiences in healthcare, client relations, marketing, project management and demonstrated skills in leadership and advocacy. Prior to joining The Alliance, she worked in Hospital Development at her local OPO in the state of New Jersey where she served as the clinical liaison to a number of Level 1 Trauma & Neuroscience centers as well as community hospitals. Her personal connection as a donor family and friend fuels her passion to support her colleagues across the donation-transplantation continuum through the development of valuable educational resources that ultimately boost performance and improve outcome measures. Deanna holds a Bachelor of Arts in Psychology and a minor degree in Public Health from Montclair State University. In her spare time, Deanna enjoys visiting vineyards, spending time with her family, and traveling in hopes of visiting all seven wonders of the world.

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