There are numerous laws, regulations and standards that govern how and when a medical professional can make an official declaration of death. What is most important to know is that hospitals and emergency medical professionals will make every effort to save a patient’s life regardless of their status as a donor.
Death can occur in one of two ways: cardiac death, when the heart is no longer able to beat on its own, and brain death, which is the irreversible loss of function of the brain, including the brain stem.
According to the Uniform Determination of Death Act, brain death is defined as the irreversible cessation of all functions of the entire brain, including the brain stem. A brain-dead person is dead, although his or her cardiopulmonary functioning may be artificially maintained for some time.
Because of the neurological nature of brain death, a controlled and extensive clinical exam occurs to make that final declaration. Brain death is final and finite; it is not in the same thing as a coma or persistent vegetative state.
Brain death determination is rare and occurs only in about 1 out of every 100 hospital deaths.
Organ donation after circulatory death (DCD) is the type of donation that was used in the early years of organ donation. Before brain death criteria was established, DCD and living related donation were the only options.
This type of donation occurs when a patient has an illness from which he or she cannot recover. The patient is not brain dead, but has no hope of recovery.
If the family is interested in donation and has made the decision to withdraw treatment, that process will occur in the operating room instead of the hospital room. The time from the family authorizing the process to the removal of support is typically no fewer than eight hours, due to the need for blood tests and other arrangements.
Once in the OR, if the patient’s heart stops within the designated time frame for donation, the team waits for several minutes to ensure that the heart has ceased functioning. At this time, a physician from the hospital, not the organ recovery team, will pronounce the patient dead. Then, the surgery to procure the organs for donation begins.
While DCD increases the number of organs available for transplant, this type of donation does not allow for organs other than the liver and kidneys to be procured in most cases. It is rare for the heart and lungs to be recovered.