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JAMA. 2009 May 13;301(18):1902-8. doi: 10.1001/jama.2009.637.

Policies on donation after cardiac death at children's hospitals: a mixed-methods analysis of variation.

Author information

1
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84113, USA. armand.antommaria@hsc.utah.edu

Abstract

CONTEXT:

Although authoritative bodies have promulgated guidelines for donation after cardiac death (DCD) and the Joint Commission requires hospitals to address DCD, little is known about actual hospital policies.

OBJECTIVE:

To characterize DCD policies in children's hospitals and evaluate variation among policies.

DESIGN, SETTING, AND PARTICIPANTS:

Mixed-methods analysis of policies collected between November 2007 and January 2008 from hospitals in the United States, Puerto Rico, and Canada in 2 membership categories of the National Association of Children's Hospitals and Related Institutions.

MAIN OUTCOME MEASURES:

Status of DCD policy development and content of the policies based on coding categories developed in part from authoritative statements.

RESULTS:

One hundred five of 124 eligible hospitals responded, a response rate of 85%. Seventy-six institutions (72%; 95% confidence interval [CI], 64%-82%) had DCD policies, 20 (19%; 95% CI, 12%-28%) were developing policies; and 7 (7%; 95% CI, 3%-14%) neither had nor were developing policies. We received and analyzed 73 unique, approved policies. Sixty-one policies (84%; 95% CI, 73%-91%) specify criteria or tests for declaring death. Four policies require total waiting periods prior to organ recovery at variance with professional guidelines: 1 less than 2 minutes and 3 longer than 5 minutes. Sixty-four policies (88%; 95% CI, 78%-94%) preclude transplant personnel from declaring death and 37 (51%; 95% CI, 39%-63%) prohibit them from involvement in premortem management. While 65 policies (89%; 95% CI, 80%-95%) indicate the importance of palliative care, only 5 (7%; 95% CI, 2%-15%) recommend or require palliative care consultation. Of 68 policies that indicate where withdrawal of life-sustaining treatment can or should take place, 37 policies (54%; 95% CI, 42%-67%) require it to occur in the operating room and 3 policies (4%; 95% CI, 1%-12%) require it to occur in the intensive care unit.

CONCLUSIONS:

Most children's hospitals have developed or are developing DCD policies. There is, however, considerable variation among policies.

PMID:
19436017
DOI:
10.1001/jama.2009.637
[Indexed for MEDLINE]

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