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Board addresses protocols for donation after cardiac death

Published on: Friday, March 23, 2007

St. Louis, Mo. -- The OPTN/UNOS Board of Directors, at its meeting today, adopted a set of "model elements" for consideration by member organizations who have protocols or are establishing protocols to recover organs from donors after cardiac death (DCD).

"Donation after cardiac death is an effective and ethically sound way to honor the wishes of donors and donor families and meet the increasing need for transplant candidates," said Sue V. McDiarmid, M.D., president of UNOS and the OPTN and chair of the OPTN/UNOS Board of Directors. "Our hospitals should place the highest priority on providing this option as a component of end of life care. It is important for everyone involved in DCD recovery to act consistently and with sensitivity for the wishes of the potential donor and the donor family. The model elements are meant to give consistent direction for DCD protocols, without attempting to prescribe specific medical practice of organ procurement organizations and hospitals."

The elements include a series of points in the DCD process including potential donor selection, donation consent, withdrawal of life-sustaining measures, pronouncement of death and organ recovery. As with all donations, the model elements also call on organ procurement organizations to ensure that no donation-related financial charges are passed to the donor family. The elements also include resource information addressing clinical and legal aspects of DCD donation.

In other action, the Board adopted new OPTN bylaw requirements regarding standards for primary physicians and surgeons at transplant centers. (As a condition of OPTN membership, each transplant program must identify at least one physician and one surgeon on staff who meet specific training and experience requirements.)

Several provisions addressed onsite medical availability of transplant surgeons and physicians. Among the new modifications, a transplant surgeon or physician may not be on call at two transplant programs more than 30 miles apart unless the specific circumstances have been reviewed and approved by the OPTN/UNOS Membership and Professional Standards Committee (MPSC). The bylaws also do not allow the same person to be named the primary transplant surgeon or physician at more than one transplant center, unless each of the facilities identify additional surgeons or physicians who can independently manage transplant patient care or unless the MPSC grants a specific exemption.

Other bylaw modifications addressed the potential of a transplant physician or surgeon relocating from a program involved in a prior situation resulting in OPTN adverse action. In that circumstance, the transplant hospital where the person is relocating may be requested to conduct investigations according to their peer review protocol and report back to the OPTN. In related action, the OPTN will require more detailed letters of recommendation for any individual the member organization names in an application to be a primary surgeon or physician.

"A hospital is responsible for its own credentialing of physicians and surgeons," said Tim Pruett, M.D., OPTN/UNOS Vice President and Chair of the MPSC. "Our intent is to ask a hospital to look into issues if a surgeon or physician relocates from a program where concerns have been raised, and for the hospital to inform us of the fact."

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