(a) Decisions for a child in OKDHS custody.  When a child is in Oklahoma Department of Human Services (OKDHS) legal custody of, regardless of custody status, the court must be involved and make any decision regarding:

• (1) withdrawal or withholding of life support systems;
• (2) hydration;
• (3) nutrition; and
• (4) approval of a Do Not Resuscitate Order.  • 1

(b) Withdrawal of life support.  Any medical procedure or intervention administered to a child in OKDHS custody that serves only to prolong the process of dying or maintain the child's condition of persistent unconsciousness is considered life-sustaining treatment.  This does not include the administration of medication or the performance of any medical treatment deemed necessary to alleviate pain or the normal consumption of food and water.  The withdrawal of life support systems is generally considered only for a patient who suffers from an incurable and irreversible condition, death within six months, or who is persistently unconscious, per Section 3101.1 et seq. of Title 63 of the Oklahoma Statutes (63 O.S. § 3101.1 et seq.).

(c) Withholding or withdrawal of hydration and nutrition.  Hydration and nutrition may be withheld or withdrawn only if the impending death would result from the underlying terminal illness or injury and not from dehydration, starvation, or both, per 63 O.S. § 3080.1.

(d) Resuscitation efforts.  A Do Not Resuscitate Order is an order issued by a licensed physician that cardiopulmonary resuscitation must not be administered.  Cardiopulmonary resuscitation includes those measures used to restore or support cardiac or respiratory function in the event of cardiac or respiratory arrest.  As a result of such an order for a child in OKDHS custody, no efforts are made to restore or support the cardiac or respiratory system.

(e) Organ donation during the life of a child in OKDHS custody.  During the life of a child in OKDHS custody, OKDHS may not consent to the anatomical gift of the body or organs of the child regardless of the child's custody status.  An anatomical gift of a donor's body or part may be made during the life of the donor for the purpose of transplantation, therapy, research, or education pursuant to 63 O.S. § 2200.4A by:

• (1) the donor, if the donor is an adult or if the donor is a minor and is:
  • (a) emancipated; or
  • (b) authorized under state law to apply for a driver license because the donor is at least 16 years of age;
• (2) an agent of the donor, unless the power of attorney for health care or other record prohibits the agent from making an anatomical gift;
• (3) a parent of the donor, if the donor is an unemancipated minor; or
• (4) the donor's guardian.

(f) Organ donation after the death of a child in OKDHS custody.  When the potential donor child is in OKDHS custody at the time of death, nine classes of persons supersede OKDHS and have the right to consent to the donation of the decedent's body or part.  When none of the nine classes of persons is reasonably available, OKDHS may consent to an anatomical gift of the decedent's body or part when:

• (1) the child donor was in OKDHS permanent custody at the time of the child's death; and
• (2) all other classes of persons listed in 63 O.S. § 2200.9A, who supersede OKDHS, have been given a reasonable opportunity to consent or object to the donation and have not done so.