Center for Bioethics, Columbia University College of Physicians and Surgeons, New York, NY, USA.
J Intensive Care Med. 2012 Jul-Aug;27(4):253-63. doi: 10.1177/0885066610397110. Epub 2011 May 16.
Despite the increasing number of policies governing organ donation after cardiac death (DCD), nothing is presently known about the informed consent process for DCD. Without guidelines, organ procurement organizations (OPOs) are likely to structure the consent process similarly to that for organ donation after brain death (DBD), despite important ethical differences between the 2 modes of organ recovery.
To describe informed consent practices used by OPOs for DCD.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, internet-based survey of the 58 OPOs in the United States.
OPO policies and reported levels of physician participation in the consent process for DCD.
Seventeen OPOs completed the survey (29%). Responders and nonresponders did not differ by DCD volume over the last year or last 5 years. None of the OPO's policies require physician involvement in obtaining written informed consent; 94% of policies require only the OPO representative to obtain written consent for DCD and 6% state that either the OPO representative or the treating physician may obtain consent; 71% of OPOs reported that discussions with family regarding DCD occur with the treating physician present less than 51% of the time and 82% indicated that the OPO representative is solely involved in obtaining consent for DCD in the majority of cases. A total of 24% of OPOs require physicians to participate in obtaining consent for procedures performed prior to death exclusively for organ preservation. No differences were found between the OPO consent practices for DCD and DBD.
None of the OPOs responding to this survey have a policy requirement for physician involvement in obtaining consent for DCD. These findings raise questions about the role of physicians in DCD and how best to maintain a patient- and family-centered focus on care for patients at the end of life while supporting organ recovery efforts.
尽管越来越多的政策规范了心死亡后器官捐献（DCD），但目前对于 DCD 的知情同意过程仍知之甚少。由于这两种器官获取模式之间存在重要的伦理差异，在没有指导方针的情况下，器官获取组织（OPO）可能会按照脑死亡后器官捐献（DBD）的方式来构建同意过程。
描述 OPO 用于 DCD 的知情同意实践。
设计、地点和参与者：在美国的 58 个 OPO 中进行了基于互联网的横断面调查。
OPO 政策和报告的医师参与 DCD 同意过程的水平。
17 个 OPO 完成了调查（29%）。应答者和未应答者在过去一年或过去 5 年的 DCD 量方面没有差异。没有一个 OPO 的政策要求医师参与获取书面知情同意；94%的政策仅要求 OPO 代表为 DCD 获得书面同意，6%的政策规定 OPO 代表或主治医生可以获得同意；71%的 OPO 报告说，与家属讨论 DCD 的情况，主治医生在场的时间不到 51%，82%的 OPO 表示，在大多数情况下，OPO 代表独自负责获取 DCD 的同意。共有 24%的 OPO 要求医生仅为器官保存而参与获取死亡前程序的同意。在 DCD 和 DBD 的 OPO 同意实践方面没有发现差异。
对这项调查做出回应的 OPO 中，没有一个要求医生参与获取 DCD 同意的政策。这些发现提出了关于医生在 DCD 中的角色的问题，以及如何在支持器官获取工作的同时，最好地维护生命末期患者和家属为中心的关怀。
