Surgery News - August 2007 - (Page 12)

OPINION FROM THE COLLEGE SURGERY NEWS • A U G U S T 2 0 0 7 e-FACS.org Expands Its Horizons—and Yours aunched in 2006, e-FACS.org, the ties. Of these, 12 are specialty communimembers-only Web portal of the ties, and 9 are subspecialty communities American College of Surgeons, has under General Surgery. The rest of the enjoyed a good response, with 18,000 communities focus on areas of special inunique visitors accounting for nearly a terest—such as minimally invasive surgery, rural surgeons, and international surgery. half-million page views. Use of this personalized, secure gateway Many provide robust information—into the Internet, which was originally rec- cluding core content, reports, algorithms, discussion forums, news feeds, ommended by the Resident links to related Web sites and and Associate Society and the podcasts, meeting dates, Committee on Young Survideos, recommended reading, geons, continues to grow and accreditation/certification among College members. Its information. success is attributable to the Each ACS chapter has been constant addition of new coninvited to designate a contact tent, resources, and tools, as member who is provided with well as changes that have been a teaching disc and instructions made based on user feedback. along with a request to keep Total access to e-FACS.org is BY GEORGE F. the chapter up to date on the given only to ACS Fellows. SHELDON, M.D., FACS portal. The international chapLimited access is granted to other members. All visitors have access to ters have been very responsive; for exama key portal feature, the Communities ple, the portal was featured at a recent meeting of the Lebanese chapter. and Specialties area. L an Fellows, Medical Students, Residents and Associate Fellows, Senior Surgeons, and Women Surgeons, a new community led by community editor Rosemary A. Kozar, M.D., FACS. Access to these five communities is given specifically to those who match the membership criteria. You are free to join or opt out of communities. Three additional communities with the following community editors have been added: Ethical Issues in Surgery (Ira J. Kodner, M.D., FACS); Palliative Care & Pain Management (Geoffrey P. Dunn, M.D., FACS); and Surgical Patient Safety (Paul F. Nora, M.D., FACS). New Web Page Features The portal’s home page has been redesigned. A new Quick Links box links to pages viewed frequently. A Google search box is also included here. Other links are to pages that are unique to each visitor: My CME allows members to track and log their CME credits, My Bookmarks lets users list their favorite Web sites and store articles in their own library, and My Specialty connects to the College’s database and recognizes each visitor’s specialty when he or she enters the portal. The Add to Bookmarks feature, available in the PubMed portlets within the Communities & Specialties area, allows users to save articles from automated news feeds to My Bookmarks. This feature will eventually include non-PubMed feeds. Other new features include the following: A polling tool on the home page, which makes it possible to use multiple-choice questions and display the results. Visitors can post their own polls in the many discussion forums available in the portal. Annual reports, which are submitted by the boards of the 10 surgical specialties recognized by the American Board of Medical Specialties. The reports are posted in the portal’s specialty communities instead of being published in the Bulletin Access to subcommittee pages within their respective community areas (for example, in the Trauma Community, separate pages for the Subcommittee on Emergency Services and Prehospital and the Subcommittee on Publications). Be Sure to Visit Visit e-FACS.org regularly. It can really make your professional life easier. ■ DR. SHELDON is Editor in Chief of e-FACS.org, as well as a professor of surgery and social medicine and former chair of surgery, University of North Carolina– Chapel Hill. He can be contacted at george_sheldon@med.unc.edu. Editorial Board The editorial board of e-FACS.org consists of 16 at-large members in addition to myself and Lazar Greenfield, M.D., FACS; 49 community editors; and 189 associate community editors. The portal now contains 44 communi- Surgical Communities Access to portal communities has been improved to provide users with optimal personalization. In addition to the specialty and special-interest communities in which you are a member by default, there are five special-interest communities: Canadi- GUEST EDITORIAL Organ Donation After Cardiac Death rgan donation has cantly in States as result Othe Healththe Unitedincreased asignifiof Resources and Services Adreversibility is recognized by persistent cessation of function during an appropriate period of observation. DCD donor ministration’s Organ Donation Break- death occurs when respiration and circuthrough Collaborative, which assesses lation have ceased after the withdrawal of every hospital death as a potential oppor- futile treatment, and cardiopulmonary tunity for donation. The number of de- function will not resume spontaneously. ceased donors has risen 23% since 2003, Cessation of cardiopulmonary function is and now averages approximately 700 per recognized by an appropriate clinical examination that reveals the abmonth. In 2006, there were sence of responsiveness, heart more than 8,000 deceased sounds, pulse, and respiratory donors in the United States— effort. a record annual total. In applying the circulatory The ethical axiom of organ criterion of death in non-DCD donation necessitates adhercircumstances, clinical examience to the dead donor rule. nation alone may be sufficient The retrieval of organs for to determine the cessation of transplantation should not circulatory and respiratory cause the death of a donor. functions. However, the urgent According to the 1980 Uniform BY FRANCIS L. Determination of Death Act DELMONICO, M.D., FACS time constraints of DCD may require more definitive proof (UDDA), death is declared legally when an individual has sustained ei- of cessation of cardiopulmonary functher irreversible cessation of circulatory tion. Confirmatory tests such as intraarand respiratory functions, or irreversible terial monitoring or Doppler study should cessation of all functions of the entire be performed. A patient who has a nonrecoverable brain, including the brain stem. Thus, a prospective organ donor’s death may be and irreversible neurologic injury that redetermined by either the cardiopul- sults in ventilator dependency but does not monary criteria (donation after cardiac fulfill brain death criteria may be a suitable death, or DCD) or neurologic criteria (do- candidate for DCD. Other conditions that may lead to consideration of DCD eligination after brain death, or DBD). DCD indicates that death is determined bility include end-stage musculoskeletal by an irreversible cessation of circulatory disease, pulmonary disease, and high and respiratory function that must pre- spinal cord injury. The Institute of Medicine (IOM) has cede the initiation of organ recovery. Irconcluded that DCD is an ethically proper approach for recovering organs from a deceased patient for the purpose of transplantation. The IOM has also recommended some important additional stipulations: Proper consent should be obtained, the donor should be ruled dead by a doctor other than a transplant surgeon, and a 5-minute period of asystole should be observed before the declaration of death to ensure that the heart will not resume beating spontaneously. The United Network for Organ Sharing (UNOS) and the Joint Commission on Accreditation of Healthcare Organizations support the recovery of organs from donors after cardiac death. UNOS now recommends that all member transplant centers and organ procurement organizations (OPOs) have a DCD protocol reviewed if a DCD is to occur. The DCD protocol should consider these model elements: No member of the transplant team and no OPO staff may participate in the guidance or administration of palliative care, or the declaration of death. There must be a determination of the location and process for withdrawal of life-sustaining measures as a component of patient management. The method of declaring cardiac death must fulfill the legal definition of death by an irreversible cessation of circulatory and respiratory functions before the pronouncement of death. Not all transplant centers or OPOs have an active DCD protocol. At this writing, perhaps 10 of the 58 OPOs in the United States have not performed a DCD recovery. There has been ethical controversy engendered by misperceptions about the determination of death. However, if the IOM prescription is fulfilled and the dead donor rule is upheld by the legal requirement of an irreversible cessation of cardiopulmonary function, DCD is ethically proper. In 2006, the number of DCDs increased to 645 donors in the United States (8% of all deceased organ donors). For some OPOs, DCD organ donation represents approximately 20% of the donors. This increase in DCD (regionally and nationally) has been accomplished with a simultaneous increase in donors after brain death. Thus, many more DCD transplants could be performed throughout the country. Every transplant center and OPO should review its current position regarding DCD. Once the attending physician and the family member or surrogate have consensually decided upon the withdrawal of futile treatment, and the legal determination of death is fulfilled, no family or potential donor should have their wishes of organ donation denied. ■ DR. DELMONICO is director of medical affairs of the Transplantation Society and professor of surgery at Harvard Medical School and Massachusetts General Hospital, Boston. http://e-FACS.org http://e-FACS.org http://e-FACS.org http://e-FACS.org

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Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

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