Donation after circulatory death planning — FFICM MCQ

Instant feedback + full explanation. One question, done properly.

HardEthics and End-of-lifeDonation after circulatory death planningFFICM

A 58-year-old woman with catastrophic hypoxic brain injury is not expected to survive after withdrawal of ventilation. Neurological death criteria are not met because some brainstem reflexes remain. Her family report she wished to donate organs. She is stable on low-dose noradrenaline. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Plan controlled donation after circulatory death with SNOD involvement

The correct answer is B: Plan controlled donation after circulatory death with SNOD involvement. This patient has a devastating hypoxic brain injury and is expected to die after withdrawal of life-sustaining treatment, but she does not fulfil death using neurological criteria because some brainstem reflexes persist, so DBD testing cannot proceed. As she is haemodynamically stable and has expressed a wish to donate, the appropriate pathway is controlled DCD, planned with the Specialist Nurse in Organ Donation (SNOD), who coordinates timing of withdrawal, family discussion and retrieval logistics. Early SNOD referral once withdrawal is decided allows donation to be explored without altering end-of-life care. Why the other options are wrong: B, Proceed with donation after neurological death testing now: Neurological death testing requires absence of all brainstem reflexes; since some reflexes remain, the legal and clinical criteria for death using neurological criteria are not met, so this pathway is not available. C, Withdraw treatment on the ward without donation discussion: This ignores the family's report of the patient's wish to donate and bypasses mandatory referral to the SNOD, denying a valid donation opportunity contrary to national referral criteria. D, Ask surgeons to retrieve organs before death is confirmed: Organ retrieval before legal confirmation of death is unlawful and represents a fundamental breach of donation practice and the dead donor rule. E, Continue futile treatment solely until cardiac arrest occurs naturally: Prolonging inappropriately futile treatment without a plan is not in the patient's best interests and does not honour her donation wishes through a properly coordinated pathway. Key point: When death using neurological criteria cannot be confirmed but death is anticipated after withdrawal, controlled DCD coordinated with the SNOD is the correct route to honour donation wishes.

Reference: NHS Blood and Transplant, ODT Clinical: Identify and refer a potential organ donor, best practice guidance, https://www.odt.nhs.uk/deceased-donation/best-practice-guidance/donor-identification-and-referral/