1Intensive Care, Monash Health, Melbourne, Australia
Objective: To report three year experience of successful implementation of donation after cardiac death (DCD) programme in a metropolitan teaching hospital.
Background: As a part of National reforms agenda for organ and tissue donation, there has been a significant focus on organ donation by DCD pathway. However hospital based organ donation teams often face many difficulties in it's successful implementation. These range from attitudes of the clinical and support staff to logistical problems. Key barriers include a lack of knowledge about DCD, psychological barriers for DCD versus brain death, concerns about whether death has been reached, beliefs about saving versus killing patients, trust in the organ donation team, moving from saving patients to being a donation advocate and concerns with the DCD process particularly time taken for the process and conflict of interest in assigning priority to management of potential donor versus other critically ill patients.
Methods: We describe our experience with regards to changing attitudes towards DCD, overcoming potential barriers and creating opportunities and strategies for gaining support, which included education initiatives, a cultural shift, a consistent DCD protocol separating care from recovery, process monitoring, and a strong sense of teamwork.
Conclusion: Our findings provide a better understanding of potential barriers, critical to the implementation of strategic plans for DCD programme in the hospital setting. Communication efforts that are able to educate healthcare professionals and eliminate misconceptions will increase support for DCD. Key to future success requires confident committed and well-trained team.
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