Survey of Nationwide Organ Procurement Organization (OPO) Practices in Verification of Death by Neurologic Criteria (DNC)
Kasra Sarhadi1, Kristopher Hendershot1, Natalie Smith1, Michael Souter1, Claire Creutzfeldt1, Abhijit Lele1, Carolina Maciel2, Julius Balogh3, David Greer4, Katharina Busl2, Ariane Lewis5, Sarah Wahlster1
1University of Washington, 2University of Florida, 3University of Arkansas for Medical Sciences, 4Boston University School of Medicine, 5NYU Langone Medical Center
Objective:
To explore Organ Procurement Organization (OPO) practices regarding verification of Death by Neurologic Criteria (DNC).
Background:
OPOs play a vital role in ensuring a sound practice of DNC determination. While national guidelines and hospital policies delineate how to determine DNC, OPO practices regarding DNC verification are not standardized and little is known about the verification process or prevalence of practice deviations determined by OPOs.
Design/Methods:
Electronic, mixed-methods survey administered to OPO representatives (directors, administrative leads) nationwide.
Results:
Twelve different OPO representatives (including medical directors, advisors, and administrators) responded across 6 geographical regions, with 8 reporting covering >50 referral hospitals. Most (92%, 11/12) reported checking DNC verification policies via American Academy of Neurology Practice Parameter (AANPP, 92%) and/or Society of Critical Care Medicine/Child Neurology Society/American Academy of Pediatrics (33%) guidelines. Also, most (83%, 10/12) reported independently reviewing and verifying each DNC determination, with 33% (4/12) listing their medical director as the reviewer. Only 25% (3/12) thought all referring hospitals followed AANPP guidelines in practice, and 42% (5/12) reported concerns about guideline-discordant hospital policies. Moreover, 75% (9/12) reported concerns about hospital clinician knowledge surrounding DNC determination, and 83% (10/12) reported receiving referrals for DNC determinations that were ultimately reversed. All respondents reported experiences with cases in which their organization requested additional information or testing (92% further clinical evaluation, 75% repeat apnea testing, 83% additional ancillary testing) due to concerns about DNC determination validity. The most common concerns were regarding possible confounding due to sedating medications (58%), metabolic abnormalities (50%), hypothermia (42%), or inappropriate conduct of apnea testing (42%).
Conclusions:
Nearly all surveyed OPOs reported a guideline-directed DNC verification process. Many reported concerns about clinician knowledge surrounding DNC determination and guideline-discordant practices and hospital policies. Research is needed to identify barriers and facilitators to systematic implementation of guideline-concordant practices across the country.