American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/555200
Process Interventions Î Use of ante mortem interventions and medications should be disclosed to surrogates at the time of consent and identified as being administered solely for the purpose of organ donation. Separate consent might be required for some ante mortem interventions consistent with hospital policies or state/local laws and regulations. Î Ante mortem interventions are ethically appropriate if they contribute to good transplant outcomes and have a low chance of harming the prospective donor. Î Post mortem donor management interventions such as extracorporeal membrane oxygenation that may stimulate physiologic functions (i.e., cardiac or brain function) require further analysis to determine their clinical usefulness and ethical merit. Determination of Death Î Death can be declared after the cessation of circulation and respiratory function for 2 minutes. Î Information about how death will be determined should be provided to the patient or the surrogates. End-of-life Care Î Surrogates should be informed during the consent process regarding: (1) how and where life-sustaining therapies will be withdrawn, (2) the amount of time they can spend with their loved one post mortem, and (3) the possibility that the patient may not die within the time interval necessary for DCDD to occur. Î Hospitals that participate in DCDD should ensure that experienced personnel with competency in palliative care are available to participate in end-of-life care if needed. Î Hospitals that participate in DCDD should have a clear policy regarding how and where patients will be cared for if they do not expire within the time interval acceptable for donation. Pediatric DCDD Î Although pediatric patients (under the age of 18 yr) cannot provide consent to their own donation, consent of the parent or of another legal surrogate can be used. Î The ethical principles related to consent, intervention, declaration of death, and end-of-life care in pediatric DCDD patients is similar to those for adults.