Donation After Circulatory Determination of Death

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This section has been reviewed and updated as of September 2018. To see past content, click on the Archive tab below.

  • DCD Outcomes

    Academic Journals

    • Outcome of Kidney Transplantation From Donor After Cardiac Death: Reanalysis of the US Mycophenolic Renal Transplant Registry – Article (subscription) – Zhu, D., McCague, K., Lin, W., Rong, R., Xu, M., Chan, L. and Zhu, T. (2018). Transplantation Proceedings, 50(5), pp.1258-1263.
  • DCD Policies

    Hospital Policy Examples

    • Donation After Cardiac Death PolicyDownload – Grady Health System
    • Donation after Circulatory Death Policy Sample – Download – Inova Fairfax Hospital
    • Donation after Circulatory Death Policy Sample Download

    OPO Policy Examples

    • Donation after Circulatory Death PolicyDownloadGift of Hope
  • Educational Tools


    • Donation After Cardiac Death Flowchart – Download – Gift of Life Michigan
    • DCD Resource for Attending Physician/Designee  – Download – Lifebanc
    • Accelerated DCD ChecklistDownload – Gift of Life Michigan
    • DCDD ChecklistDownload – Gift of Life Michigan
    • DCD Evaluation GuidelinesDownload – Blood Center of Wisconsin, Wisconsin Donor Network
    • DCD Rapid Recovery OutlineDownload – Blood Center of Wisconsin, Wisconsin Donor Network
    • FCS Family RoadmapDownload – Blood Center of Wisconsin, Wisconsin Donor Network
    • DCD & BD Handoff ChecklistDownload – Gift of Life Michigan
    • DCD Onsite Evaluation ToolDownload
    • DCD Phone Evaluation ToolDownload

    Academic Journals

    • Protocols for Uncontrolled Donation after Circulatory Death: A Systematic Review of International Guidelines, Practices and Transplant OutcomesArticle – Ortega-Deballon I, Hornby L, Shemie SD. (2015), Crit Care, 19: 268.
  • Ethics on DCD

    Academic Journals

    • An Analysis of Heart Donation after Circulatory Determination of DeathArticle (subscription) – Dalle Ave, A., Shaw, D. and Bernat, J. (2016). Journal of Medical Ethics, 42(5), pp.312-317.
    • Characterizing Cardiac Donation After Circulatory Death: Implications for Perfusion PreservationArticle – Brant, S., Cobert, M., West, L., Shelton, J., Jessen, M. and Peltz, M. (2014). The Annals of Thoracic Surgery, 98(6), pp.2107-2114.
    • Circulatory Death Determination in Uncontrolled Organ Donors: A Panel ViewpointArticle (subscription) – Bernat, J., Bleck, T., Blosser, S., Bratton, S., Capron, A., Cornell, D., DeVita, M., Fulda, G., et al. (2014). Annals of Emergency Medicine, 63(4), pp.384-390.
    • Controlled Donation After Circulatory Determination of DeathArticle (subscription) – Dalle Ave, A. and Shaw, D. (2016). Journal of Intensive Care Medicine, 32(3), pp.179-186.
    • Donation after Brain Circulation Determination of DeathArticle – Dalle Ave, A. and Bernat, J. (2017). BMC Medical Ethics, 18(1).
    • Enabling Donation after Cardiac Death in the Emergency Department: Overcoming Clinical, Legal, and Ethical ConcernsArticle (subscription) – Dailey, M., Geary, S., Merrill, S. and Eijkholt, M. (2017). The Journal of Emergency Medicine, 52(4), pp.588-592.
    • Ethical, Legal, and Societal Issues and Recommendations for Controlled and Uncontrolled DCDArticle– Haase, B., Bos, M., Boffa, C., Lewis, P., Rudge, C., Valero, R., Wind, T. and Wright, L. (2016). Transplant International, 29(7), pp.771-779.
    • Uncontrolled Organ Donation after Circulatory Death: Potential Donors in the Emergency DepartmentArticle (subscription) – Reed, M. and Lua, S. (2013). Emergency Medicine Journal, 31(9), pp.741-744.
  • FAQ for Hospital Staff and Donor Families


    • DCD Brochure for Hospitals – Download – Gift of Hope
    • DCD vs. BD InfographicDownload – Gift of Life Michigan 
    • DCD vs. BD InfographicDownload – Texas Organ Sharing Alliance
    • DCD InfographicDownload – Texas Organ Sharing Alliance
    • Key Difference Between DCD and BDDownload – Texas Organ Sharing Alliance
  • OR Flowsheets and Set Up

    OR Flowsheets

    • DCD – Post Extubation Data Tracking Form – Download – Gift of Hope
    • Withdrawal of Life Support FlowsheetDownload

    OR Set Up

    • DCD Operating Room & Organ Recovery Process – Download – Gift of Life Michigan
    • DCD OR SetupPhotos
    • BD vs. DCD OR Set UpDownload –  Gift of Life Michigan
    • OR Procedure for Donation after Circulatory DeathDownload – Lifebanc
    • DCD Surgeon GuidelinesDownload – Gift of Life Michigan
    • Major Instrument Inventory ChecklistDownload – Gift of Life Michigan
    • DCD OR Prep ToolDownload – Mid-America Transplant
  • Archive
    The archive library contains articles and resources that were originally published 5+ years ago and are no longer current.

    DCD Outcomes

    Donation Rate

    • Estimated Supply of Organ Donors After Circulatory Determination of Death: A Population-Based Cohort Study – Article – Halpern SD, Barnes B, Hasz RD, et al. (2010), JAMA, 304(23): 2592-2594. doi: 10.1001/jama.2010.1824. 


    • Cold Machine Perfusion Versus Static Cold Storage of Kidneys Donated After Cardiac Death: A UK Multicenter Randomized Controlled Trial – Article – Watson CJ, Wells AC, Roberts RJ, et al. (2010), AM J Transplant, 10(9): 1991-1999. doi: 10.1111/j.1600-6143.2010.03165.x.
    • Machine Perfusion Versus Cold Storage for the Preservation of Kidneys Donated After Cardiac Death – Article – Jochmans I, Moers C, Smits JM, et al. (2010), Ann Surg, 252(5): 756-764. doi: 10.1097/SLA.0b013e3181ffc256.
    • Short- and Long-Term Outcomes with the Use of Kidneys and Livers Donated after Cardiac Death – Article – Doshi MD, Hunsicker LG. (2007), Am J Transplant, 7(1): 122-129. Epub 2006 Oct 25.


    • A Comprehensive Risk Assessment of Mortality Following Donation after Cardiac Death Liver Transplant – An Analysis of the National Registry – Article – Jay C, Ladner D, Wang E, et al. (2011), J Hepatol, 55(4): 808-813. doi: 10.1016/j.jhep.2011.01.040. Epub 2011 Feb 19.
    • Biliary Complications After Liver Transplantation From Donation After Cardiac Death Donors: An Analysis of Risk Factors and Long Term Outcomes from a Single CenterArticle – Foley DP, Fernandez LA, Leverson G, et al. (2011), Ann Surg, 253(4): 817-825. doi: 10.1097/SLA.0b013e3182104784.
    • Donation after Cardiac Death Liver Transplantation: Predictors of Outcome – Article – Mathur AK, Heimbach J, Steffick DE, et al. (2010), Am J Transplant, 10(11): 2512-2519. doi: 10.1111/j.1600-6143.2010.03293.x.
    • Ischemic Cholangiopathy After Controlled Donation After Cardiac Death Liver Transplantation A Meta-analysis – Article – Jay CL, Lyuksemburg V, Ladner DP, et al. (2011), Ann Surg, 253(2): 259-264. doi: 10.1097/SLA.0b013e318204e658.


    • Donation after Cardiac Death Lung Transplantation Outcomes – Article – Wigfield CH, Love RB. (2011), Curr Opin Organ Transplant, 16(5): 462-468. doi: 10.1097/MOT.0b013e32834a99ac.
    • Donation after Cardiac Death: A 29-Year Experience – Article – Bellingham JM, Santhanakrishnan C, Neidlinger N, et al. (2011), Surgery, 150(4): 692-702. doi: 10.1016/j.surg.2011.07.057.
    • Lungs from Donation after Circulatory Death Donors: An Alternative Source to Brain-Dead Donors? Midterm Results at a Single Institution – Article – Zych R, Popov AF, Amrani M, et al. (2012), Eur J Cardiothorac Surg. doi: 10.1093/ejcts/ezs096.


    • Islet Transplantation Using Donors After Cardiac Death: Report of the Japan Islet Transplantation Registry – Article – Saito T, Gotoh M, Satomi S, et al. (2010), Transplantation, 90(7): 740-747. doi: 10.1097/TP.0b013e3181ecb044.
    • Outcomes of Pancreas Transplantation in the United States Using Cardiac-Death Donors – Article – Salvalaggio PR, Davies DB, Fernandez LA, Kaufman DB. (2006), Am J Transplant, 6(5 Pt 1): 1059-1065.
    • Outcomes of Simultaneous Pancreas–Kidney Transplantation from Brain Dead and Controlled Circulatory Death Donors – Article – Fernandez LA, Di Carlo A, Odorico JS, et al. (2005), Ann Surg, 242(5): 716-723. doi: 10.1097/01.sla.0000186175.84788.50

    DCD Policies


    • DCD EISOR Standard of Practice – Download – Henry Ford Health System, IL
    • DCD Hospital PolicyDownload – Henry Ford Health System, IL
    • Hospital Clinical DCD PolicyDownload – Spectrum Health, MI
    • Policies on Donation After Cardiac Death at Children’s Hospitals A Mixed-Methods Analysis of Variation – Article – Antommaria AH, Trotochaud K, Kinlaw K, et al. (2009), JAMA, 301(18): 1902-1908. doi: 10.1001/jama.2009.637.
    • The Impact of Variation in Donation After Cardiac Death Policies Among Donor Hospitals: A Regional Analysis – Article – Rhee JY, Ruthazer R, O’Connor K, et al. (2011), AM J Transplant, 11(8): 1719-1726. doi: 0.1111/j.1600-6143.2011.03634.x. Epub 2011 Jul 12.

    Education Tools

    Algorithm & Flowcharts

    • Donation After Cardiac Death Algorithm – Download – OneLegacy
    • Donation After Cardiac Death Process Algorithm – Download – Hurley Medical Center
    • ASTS Recommended Practice Guidelines for Controlled Donation after Cardiac Death Organ Procurement and TransplantationArticle – Reich DJ, Mulligan DC, Abt PL, et al; ASTS Standards on Organ Transplantation Committee. (2009) Am J Transplant, 9(9): 2004-2011. doi: 10.1111/j.1600-6143.2009.02739.x. Epub 2009 Jul 16.

    Death Progression

    • Development of the University of Wisconsin donation After Cardiac Death Evaluation Tool – Article – Lewis J, Peltier J, Nelson H, et al. (2003), Prog Transplant, 13(4): 265-273.
    • External Validation of a Prognostic Model Predicting Time of Death after Withdrawal of Life Support in Neurocritical Patients – Article – de Groot YJ, Lingsma HF, Bakker J, et al. (2012), Crit Care Med, 40(1): 233-238. doi:  10.1097/CCM.0b013e31822f0633.
    • Prediction of Time of Death after Withdrawal of Life-Sustaining Treatment in Potential Donors after Cardiac Death – Article – Wing J, Snoeijs MG, Brugman CA, et al. (2012), Crit Care Med, 40(3): 766-769. doi: 10.1097/CCM.0b013e318232e2e7.
    • Time to Cardiac Death After Withdrawal of Life-Sustaining Treatment in Potential Organ Donors – Article – Suntharalingam C, Sharples L, Dudley C, et al. (2009), Am J Transplant, 9(9): 2157-2165. doi: 10.1111/j.1600-6143.2009.02758.x. Epub 2009 Jul 22.

    Graft Failure

    • A Comprehensive Risk Quantification Score for Deceased Donor Kidneys: The Kidney Donor Risk Index – Article – Rao PS, Schaubel DE, Guidlinger MK, et al. (2009), Transplantation, 88(2): 231-236. doi: 10.1097/TP.0b013e3181ac620b.
    • A Simplified Donor Risk Index for Predicting Outcome After Deceased Donor Kidney Transplantation – Article – Watson CJ, Johnson RJ, Birch R, et al. (2012), Transplantation, 93(3): 314-318. doi: 10.1097/TP.0b013e31823f14d4.
    • Characteristics Associated with Liver Graft Failure: The Concept of a Donor Risk Index – Article – Feng S, Goodrich NP, Bragg-Gresham JL, et al. (2006), Am J Transplant, 6(4): 783-790.
    • Liver Transplantation Using Organ Donation After Cardiac Death: A Clinical Predictive Index for Graft Failure-Free Survival – Article – Hong JC, Yersiz H, Kositamongkol P, et al. (2011), Arch Surg, 146(9): 1017-1023. doi: 10.1001/archsurg.2011.240.
    • Systematic Evaluation of Pancreas Allograft Quality, Outcomes and Geographic Variation in Utilization – Article – Axelrod DA, Sung RS, Meyer KH, et al. (2010), Am J Transplant, 10(4): 837-845. doi: 10.1111/j.1600-6143.2009.02996.x. Epub 2010 Feb 1.

    Ethics on DCD


    • A Systematic Review of Autoresuscitation after Cardiac Arrest – Article – Hornby K, Hornby L, Shemie SD. (2010), Crit Care Med, 38(5): 1246-1253. doi: 10.1097/CCM.0b013e3181d8caaa.
    • Autoresuscitation after Asystole in Patients Being Considered for Organ Donation – Article – Sheth KN, Nutter T, Stein DM, et al. (2012), Crit Care Med, 40(1): 158-161. doi: 10.1097/CCM.0b013e31822f0b2a.

    Death Determination

    • Ethical Controversies at End of Life after Traumatic Brain Injury: Defining Death and Organ DonationArticle – Souter M, Van Norman G. (2010), Crit Care Med, 38(9 Suppl): S502-509. doi: 10.1097/CCM.0b013e3181ec5354.
    • How the Distinction between “Irreversible” and “Permanent” Illuminates Circulatory-Respiratory Death Determination – Article – Bernat JL. (2010), J Med Philos, 35(3): 242-255. doi: 10.1093/jmp/jhq018. Epub 2010 May 3.
    • International Perspective on the Diagnosis of DeathArticle – Gardiner D, Shemie S, Manara A, Opdam H. (2012), Br J Anaesth, 108 Suppl 1: i14-28. doi: 10.1093/bja/aer397.


    • Donation after Circulatory Death: Burying the Dead Donor RuleArticle – Rodriguez-Arias D, Smith MJ, Lazar NM. (2011), Am J Bioeth, 11(8): 36-43. doi: 10.1080/15265161.2011.583319.
    • Further Deliberating Burying the Dead Donor Rule in Donation After Circulatory Death – Article – Chen YY, Ko WJ. (2011), Am J Bioeth, 11(8): 58-59. doi: 10.1080/15265161.2011.591211.
    • Organ Donation after Circulatory Determination of Death: Lessons and Unresolved Controversies – Article – Childress JF. (2008), J Law Med Ethics, 36(4): 766-771, 610. doi: 10.1111/j.1748-720X.2008.00336.x.
    • Organ Procurement After Cardiocirculatory Death: A Critical Analysis – Article – Rady MY, Verheijde JL, McGregor J. (2008), J Intensive Care Med, 23(5): 303-312. doi: 10.1177/0885066608320928. Epub 2008 Jul 22.
    • The Boundaries of Organ Donation after Circulatory DeathArticle – Bernat JL. (2008), N Engl J Med, 359(7): 669-71. doi: 10.1056/NEJMp0804161.

    OR Flowsheets and Set Up

    • Controversy and Consensus on Pediatric Donation After Cardiac Death: Ethical Issues and Institutional Process – Article – Harrison CH, Laussen PC. (2008), Transplant Proc, 40(4): 1044-1047. doi: 10.1016/j.transproceed.2008.03.064.
    • Donation after Cardiac Death in Pediatric Critical CareArticle – Kolovos NS, Webster P, Bratton SL. (2007), Pediatr Crit Care Med, 8(1): 47-49.
    • Building a Successful DCD Program: Planning and Leading Change – Article – Chambers-Evans J, Goulet L, Sherry W, et al. (2008), Dynamics, 19(3): 17-21.
    • Donation After Circulatory Death – Article – Manara AR, Murphy PG, O’Callaghan G. (2012), Br J Anaesth, 108 (suppl 1): i108-i121. doi: 10.1093/bja/aer357
    • Use of Tissue Plasminogen Activator in Liver Transplantation from Donation After Cardiac Death Donors – Article – Hashimoto K, Eghtesad B, Gunasekaran G, et al. (2010), Am J Transplant, 10(2): 2665-2672. doi: 10.1111/j.1600-6143.2010.03337.x

Additional Resources Are Available In:

Checklists & Forms

Pediatric Donation