Current Evidence and Best Practices in Palliative Care for Patients Undergoing Evaluation for Donation after Circulatory Death: A Narrative Review

Objective: This narrative review aims to summarize best practices in palliative care for patients undergoing evaluation for organ donation. Background: Palliative care clinicians are uniquely positioned to improve care for potential organ donors and their families. When ongoing life support is no longer consistent with the patient's/family's goals, inpatient palliative care clinicians should be able to recognize and advocate for the end-of-life (EOL) priorities of patients who are potential organ donors. This includes guiding communication during decision-making, as well as providing symptom management for patients and psychosocial support for patients and caregivers. Methods: We conducted a narrative review of published literature and policies relating to the role of palliative care in potential organ donors. Results: Families of organ donors report a high rate of satisfaction with the decision to pursue organ donation; however, family distress remains common. Moral distress is also common among clinicians caring for patients undergoing organ donation, which can stem from concern for under-treatment of symptoms, worries that medications for comfort are being used to hasten death, and lack of clear roles and expectations in managing the dDCD process. Discussion: We present strategies for supporting and communicating with patients and families prior to and during evaluation for organ donation. We also outline a framework for symptom management in the setting of potential dDCD, emphasizing that potential organ donors should always receive EOL symptom management in line with current best practices for withdrawal of life-sustaining treatments, though limited guidance exists for applying these practices in the context of anticipated dDCD. Finally, we discuss the role of palliative care in mitigating moral distress among medical teams and Organ Procurement Organization staff caring for patients who are potential organ donors.