Medical Education Considerations regarding Donation After Circulatory Death (DCD)

Key Message : Palliative care fellows report limited comfort and confidence with Donation After Circulatory Death (DCD), highlighting a critical gap in current fellowship training.

Abstract: Donation After Circulatory Death (DCD) refers to organ donation following irreversible cessation of cardiopulmonary function rather than brain death. (I)(II) Although DCD has expanded the donor pool, variability in practice and clinician preparedness remain concerns. (II)(III) A recent New York Times op-ed cited inadequate hospital training as a factor in ethically concerning procurement attempts (III)(IV). Prior studies have also recommended integrating palliative care specialists into DCD protocols to ensure best practices and compassionate end-of-life care.(V)

To evaluate training gaps, we conducted a needs assessment among nine current and recent ( < 1 year post-fellowship) palliative medicine fellows to assess comfort and confidence in managing DCD cases. Participants completed a 5-point Likert-scale survey (1 = not at all confident; 5 = extremely confident). Five of nine respondents rated “1” in their knowledge of DCD timing, criteria, and procedural steps. Similarly, five reported low confidence (scores 1–2) in explaining the process to other clinical teams. Overall, respondents demonstrated poor comfort and limited knowledge regarding DCD protocols.

These findings suggest that palliative care fellowship training provides minimal preparation for involvement in DCD cases. Future work should include a national survey of fellowship trainees to characterize DCD education within palliative curricula and explore attending physicians’ familiarity with institutional policies. Strengthening DCD education across training programs could better equip palliative clinicians to support ethical donation practices and advocate effectively for donors and their families.

References: I. Lustbader D, Goldstein MJ. Organ Donation After Cardiac Death. Fast Fact No. 242; Palliative Care Network of Wisconsin. Published March 2, 2019. Available from: https://www.mypcnow.org/fast-fact/organ-donation-after-cardiac-death/
(accessed July 30, 2025).
II. Smith M, Domínguez-Gil B, Greer DM, Manara AR, Souter MJ. Organ donation after circulatory death: current status and future potential. Intensive Care Med. 2019;45(3):310-321. doi:10.1007/s00134-019-05533-0
III. Rosenthal BM, Tate J. A Push for More Organ Transplants Is Putting Donors at Risk. The New York Times. July 20, 2025. Available from: https://www.nytimes.com/2025/07/20/us/organ-transplants-donors-alive.html
(accessed July 30, 2025).
IV. Rosenthal BM. Doctors Were Preparing to Remove Their Organs. Then They Woke Up. The New York Times. June 6, 2025. Available from: https://www.nytimes.com/2025/06/06/us/kentucky-organ-donations.html
(accessed July 30, 2025).
V. Cappucci SP, Smith WS, Schwartzstein R, et al. End-of-Life Care in the Potential Donor after Circulatory Death: A Systematic Review. Neurohospitalist. 2023;13(1):61-68. doi:10.1177/19418744221123194. Epub 2022 Oct 9. PMID: 36531837; PMCID: PMC9755608.