Uncontrolled Organ Donation after Cardiac Death SAEM PULSE | MAY-JUNE 2021
By Casey Carr, MD, and Torben Becker, MD, PhD
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A 55-year-old man collapses while performing land care at home and is found to be in cardiac arrest. He receives advanced cardiac life support in the prehospital setting, and when he does not obtain a spontaneous return of circulation, he is transported to the nearest emergency department. Despite further prolonged attempts at resuscitation, his initial rhythm of ventricular fibrillation devolves into asystole, no cardiac motion is noted on bedside ultrasound, and his end tidal CO2 is consistently less than 10 mm Hg. His time of death is declared. His
driver’s license is obtained in order to contact next of kin — and he is found to have opted in to be an organ donor. Is there a mechanism for this patient to donate his organs? Are there differences in approach in countries outside of the United States? What are the ethical considerations of this approach? The supply for organs for deceased donor transplantation has hit a plateau in the United States despite substantial efforts to increase organ donation rates over the past 10 years. While
organ donation after brain death (DBD) remains the most common form of organ donation, nonstandard forms of donation, such as donation after cardiac death (DCD) have been explored in response to this organ shortage. DCD can be categorized as controlled or uncontrolled. Controlled DCD (cDCD) occurs in the hospitalized setting after planned withdrawal of care. Donation in this setting accounts for less than 10% of all U.S. organ donations. Uncontrolled DCD (uDCD) occurs after unexpected cardiac death, frequently outside of the hospital. While the Institute of Medicine
