Table 7 Concerns with policies on donation after cardiocirculatory death in children's hospitals in the United States, Canada, and Puerto Rico [142].
Topic of concern | Examples | % of protocols |
|---|---|---|
Death determination | Pulselessness can be determined by palpation alone (a highly inaccurate method [161, 162]. | 14% |
| Â | No specification of method to determine pulselessness. | 11% |
| Â | No specification of duration of absent circulation until organ harvest. | 10% |
| Â | Fewer than 5 minutes of absent circulation until organ harvest. | 10% |
Conflicts of interest | Transplant personnel are precluded from declaring death. | 88% |
| Â | Transplant personnel are excluded from premortem donor management. | 51% |
| Â | Physicians caring for potential organ recipients are excluded from participating in premortem donor management or declaration of donor death. | 32% |
| Â | If the family raises a question about organ donation, donation after cardiocirculatory death can be discussed with the family prior to a withdrawal of life support decision. | 21% |
Premortem interventions | Premortem interventions are prohibited. | 3% |
| Â | Premortem heparin is used. | 55% |
| Â | Premortem vasodilator(s) are used. | 18% |
| Â | Premortem vessel cannulation is used. | 36% |
| Â | Consent is required for premortem interventions. | 75% |
Palliative care of donor | Medication intended to hasten death is precluded. | 44% |
| Â | Withdrawal of life support occurs only in the operating room. | 54% |
| Â | Of those having withdrawal of life support in the operating room, the family is allowed to remain until death is declared. | 48% |
| Â | The family is permitted to view the body after organ removal. | 27% |
Voluntariness of consent | The family can withdraw consent at any time. | 16% |