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Guidelines due to be published on organ donation after circulatory death

DCD occurs when a patient donates organs following the determination of death by cardio-respiratory criteria.  

President of the Society, Dr Rory Dwyer, said the guidelines are an important development for organ donation. 

The primary author is Dr James O’Rourke, Consultant in Intensive Care at Beaumont Hospital, Dublin, who previously authored a DCD clinical practice guideline, which was endorsed by the Intensive Care Society in 2012.

“This is a pretty comprehensive document and there has been a fair bit of work on making it as user-friendly as possible,” Dr Dwyer told the Medical Independent (MI).

“It talks about the legal, moral and ethical background and about the sort of patients who are suitable. There is a very detailed guideline as to what the procedures for donation after cardiac death would entail.”

In describing the altruistic nature of donation, the first page of the guideline includes a quote by Cardinal Joseph Ratzinger before he became Pope Benedict XVI, describing donation as “an act of love that is morally licit”.

Most DCD cases in Ireland have been at Beaumont Hospital, but for other hospitals “it is a bit of a new departure” and the guidelines will form part of providing the necessary support and background, outlined Dr Dwyer.

A paper co-authored by Dr O’Rourke in the Irish Medical Journal in 2014 noted that DCD is necessary because brain stem death is being diagnosed less frequently in Ireland. Road deaths had decreased by more than 50 per cent within the previous 14 years, a statistic “known to correlate closely with organ donation rates”. Organ donor patients who died as a result of trauma from any cause were decreasing, while advances in neuro-critical care had also decreased the number of people who progressed to brain stem death.

A HSE spokesperson said there were four DCD donations in 2014, and four in 2015. “The publication of guidelines and education of donating hospitals and retrieval teams is required prior to the nationwide roll-out of DCD.”

Meanwhile, the Society is also updating guidelines on diagnosis of brain death in adults. The guidelines have been further developed in relation to confirmatory tests for brain death, with more background information provided, Dr Dwyer told MI.

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