TY - JOUR
T1 - Policies on donation after cardiac death at children's hospitals
T2 - A mixed-methods analysis of variation
AU - Matheny Antommaria, Armand H.
AU - Trotochaud, Karen
AU - Kinlaw, Kathy
AU - Hopkins, Paul N.
AU - Frader, Joel
PY - 2009/5/13
Y1 - 2009/5/13
N2 - 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 polices 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.
AB - 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 polices 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.
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U2 - 10.1001/jama.2009.637
DO - 10.1001/jama.2009.637
M3 - Article
C2 - 19436017
AN - SCOPUS:65549128062
SN - 0098-7484
VL - 301
SP - 1902
EP - 1908
JO - JAMA
JF - JAMA
IS - 18
ER -