Australasian Anaesthesia 2011 - Australian and New Zealand ...

106 Australasian Anaesthesia 2011 The Last Frontier: Donation after Cardiac Death (DCD) reaches Western Australia 107THE DCD PROCEDUREThe following Timelines delineate stages of DCD decision-making and practice:DCD TimelinesPatient receives treatment in theIntensive Care Unitthe patient does not respond totreatment clinical progress is poorthe patient’s inevitable outcomebecomes apparent to cliniciansand familydiscussion with family reinevitable outcome“decoupled” conversation withfamily re end-of-life possibilitiesi.e. withdrawal of therapy + - DCDfamily consent to DCD inaccordance with the patient’swishesOperating Theatre times organised based onfamily and facility’s wishes and availabilityDuty Anaesthetist informed of timingPlans to meet in the ICU one hour prior towithdrawal of therapy to go through eachICU participant’s role in the DCD procedurePlans to meet in the Operating Theatreone hour prior to withdrawal of therapyto go through each OT participant’s rolein the DCD procedureMeeting in the Operating Roomone hour prior to withdrawal of therapyLed by the Donor Co-ordinator,To include the Anaesthetist,Operating Theatre Timeline – Time (minutes)Time (minutes) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17withdrawal of futile treatmentwithdrawal of endotracheal tube/inotropes etc by Intensive Carestaff at pre-arranged timefamily present if desiredSBP < 50mmHg(warm ischaemia time)all times recorded by Donor Co-ordinatorloss ofcirculationdeathdocumentedproceed toOperatingTheatresurgerydeclaration and documentation of deathby senior medical officers participating in patient’s careDesignated Officer’s release of the body