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Organ Donation Policies Vary Among Children's Hospitals
Date:5/12/2009

More research, better adherence to recommendations needed, study suggests

TUESDAY, May 12 (HealthDay News) -- Children's hospitals have widely varying policies on organ donation after cardiac death (DCD), according to researchers, who asked 124 hospitals in the United States, Puerto Rico and Canada about their policies in 2007 and 2008.

The study authors received responses from 105 hospitals, and found that 72 percent of them had DCD policies, while policies were being developed in 19 percent, and 7 percent did not have and were not developing policies.

Of the 73 hospitals with DCD policies that were analyzed, 61 (84 percent) specified criteria or tests for declaring death, including electrocardiogram (ECG) findings, no pulse, no breathing, and unresponsiveness. Four policies required total waiting periods prior to organ removal that conflict with professional guidelines: One policy had a waiting period of less than 2 minutes, and three policies had waiting periods of longer than 5 minutes.

The researchers also found that 64 policies (88 percent) didn't allow transplant personnel to declare death, and 51 percent prohibited them from being involved in premortem (taking place immediately before death) management.

The importance of palliative care was noted in 65 policies (89 percent), but only 7 percent recommended or required palliative care consultation. The use of medications with the intention to hasten death was prohibited in 32 policies (44 percent), the researchers found.

The location of withdrawal of life-sustaining treatment was specified in 68 policies (93 percent), with the majority (54 percent) requiring withdrawal to occur in the operating room. Other locations specified in policies included areas adjacent to the operating room (19 percent), the emergency department (4 percent), or the intensive care unit (4 percent).

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