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Board addresses donation upon circulatory death, advocacy for living donors, plain language policies

Atlanta - At its meeting November 11 and 12, the OPTN/UNOS Board of Directors voted unanimously to improve requirements for developing protocols for donation upon circulatory death (DCD). Under these requirements, organ procurement organizations (OPOs) must address key medical and ethical issues in the individual DCD protocols they develop with donor hospitals within their service area. The requirements had not been updated since they were originally established in 2007.

"The requirements add new safeguards for the interests of potential organ donors and address questions that had arisen from the previous guidance," said OPTN/UNOS President Kenneth Andreoni, M.D. "For many people who wish to save lives through donation, DCD is the only way to honor their wish. We must ensure that the donation process allows the utmost consideration of their rights and interests."

The requirements promote consistency among DCD protocols nationwide by directing that each protocol specifically address a defined set of elements including donor evaluation, consent, declaration of death, and the organ recovery process. The requirements do not impose specific treatment recommendations, since each protocol must address capabilities and standards unique to the hospital and OPO. Among the issues clarified within the new requirements is that OPO staff may not initiate discussion with a potential DCD donor or donor family prior to a decision to withdraw life-sustaining medical treatment.

In other action, the Board approved updated requirements for the qualifications and responsibilities of independent donor advocates (IDAs) at hospitals that recover kidneys from living donors. The IDA serves as a resource for the potential living donor and represents his/her interests in donor evaluation, separate from the medical decisions related to the potential transplant recipient.

The revised requirements address specific information the IDA must discuss with the potential living donor regarding psychosocial evaluation and medical evaluation. They also provide more specificity about the IDA's duties and responsibilities and require transplant programs to establish a process to address potential grievances raised by the IDA concerning the rights and best interests of the donor.

The Board also approved a rewrite of OPTN policies to enhance understanding through greater use of plain language and reorganization to make it easier to locate policies relating to a specific topic.

United Network for Organ Sharing (UNOS) serves as the Organ Procurement and Transplantation Network (OPTN) by contract with the U.S. Department of Health and Human Services, Health Resources and Services Administration, Division of Transplantation. The OPTN brings together medical professionals, transplant recipients and donor families to develop organ transplantation policy.