Donation after circulatory death: A case study

Abstract

Introduction: Donation after circulatory death (DCD) represents a major source of organs for the future expansion of transplantation practice. The UK has seen a substantial increase in controlled DCD, and in 2015/16, this type of donation represented 42% of all deceased organ donors.1 The success of this programme is attributed to the provision of legal, ethical, and professional guidance, and the underpinning principle of routinely viewing controlled DCD as a legitimate part of end-of-life care.1 This presentation evaluates the care pathway for controlled DCD through the lens of a donor family. Method: A case of controlled DCD was selected from a UK national study of bereaved families’ experiences of organ and tissue donation, and perceived influences on their decision making.2 The study received ethical approval, and reported for the first time within UK, the experiences and outcomes for a sample of families who gave consent to DCD. [R, the case], a 61 year-old male was admitted to intensive care following a brain haemorrhage. His family comprised two sisters, who were the next-of-kin donation decision makers. Qualitative, directed content analysis3 was the selected method of case analysis. This involved a systematic process of coding and categorising the data. The coding framework was based on pre-established criteria, namely an established framework for determining the past, present and future dimensions of the families’ temporal landscape.4 Further, we analysed the case to determine compliance with best practice guidance for controlled DCD in the UK. Results: The case portrayed intimate detail of the family’s donation decision and the apparent influences of prior knowledge, experience, attitudes and beliefs; the moment in time when the family experienced the potential for organ donation; and the perceived expectations and outcomes arising from their decision. The case provided evidence of high quality care and communication as perceived by the donor family, and the application of national guidance in the delivery of local practice. Conclusion: Individual case analysis provided an in-depth, holistic understanding of a donor family’s experience of controlled DCD. Donor family interpretations make an important contribution to evaluating the design and delivery of DCD programs at the end of life.