1. Michael McManus, MD, MA Munson Medical Center Bioethics Coordinator Institutional Review Chair

2. Due Diligence Before implementing a DCD policy, meetings were held with: ICUSocial Work CCUOperating Room CardiologistsHospitalists IntensivistsRespiratory Therapy Neurologists

3. Due Diligence After listening to departmental concerns, revisions were made in the policy and it was approved by: –Medical Executive Committee –Hospital Board Conscientious opt-out was part of the policy.

4. Mock DCD A mock DCD drill was held in February 2007 and a follow-up in March 2008. All of the above participated as a 'donor' was taken to the OR area, life support was withdrawn, death was declared and organs were recovered.

5. Follow Up on Mock DCD As a result of this, modifications were made in addressing family concerns, OR comfort with withdrawl A 'kit' was made up of all medications, supplies needed by the treating team.

6. DCD “Kit” - Nursing Death certificate Sign on to electronic chart in OR prior to going to OR Transport monitor Rhythm strip sheet IV fluids – including narcotics and other IV fluids to last t2 hours Extra drugs, syringes needed for comfort care Washcloths/towels for extubation Tissue boxes available for family if they are to be present for extubation Heparin 30,000 units (300 units per kilo)

7. DCD “Kit” – Respiratory Therapy Ambu Bag for transport Suction supplies Adhesive remover/Scissors Oxygen tank for transport Portable ventilator