Factors That Complicated the Implementation of a Program of Donation After Unexpected Circulatory Death of Lungs and Kidneys. Lessons Learned From a Regional Trial in the Netherlands

Leonie H Venema*, Aukje Brat, Danielle M Nijkamp, Christina Krikke, Henri Gd Leuvenink, Wim C de Jongh, Tjarda N Tromp, J Adam Van der Vliet, Bas W J Bens, Michiel E Erasmus

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: Organ shortage remains a problem in transplantation. An expansion of the donor pool could be the introduction of unexpected donation after circulatory death (uDCD) donors. The goal of this study was to increase the number of transplantable kidneys and lungs by implementing a uDCD protocol.

METHODS: A comprehensive protocol for uDCD donation was developed and implemented in the emergency departments (ED) of three transplant centres. All out of hospital cardiac arrest (OHCA) patients were screened for uDCD donation. Inclusion criteria were declaration of death in the ED, age (< 50y kidneys, < 65y lungs), witnessed arrest, and basic and advanced life support started within 10 min and 20 min, respectively.

RESULTS: A total of 553 OHCA patients were reported during the project of which 248 patients survived (44.8%). A total of 87 potential lung and 42 potential kidneys donors were identified. A broad spectrum of reasons resulted in termination of all uDCD procedures. Inclusion and organ-specific exclusion criteria were the most common reason for not proceeding followed by consent. None of the potential donors could be converted into an actual donor.

CONCLUSION: Although uDCD potential was shown by successful recognition of potential donors in the ED, we were not able to transplant any organs during the study period. The Dutch EMS guidelines to stop futile OHCA in the prehospital setting and the strict use of in-and exclusion criteria like age and witnessed arrest hampered the utilization. A prehospital uDCD protocol to bring all OHCA patients who are potential uDCD candidates to an emergency department would be helpful in creating a successful uDCD program.

Original languageEnglish
Pages (from-to)E256-E262
Number of pages7
JournalTransplantation
Volume103
Issue number9
Early online date24-Jun-2019
DOIs
Publication statusPublished - Sep-2019

Keywords

  • UNCONTROLLED ORGAN DONATION
  • HEART-BEATING DONORS
  • CARDIAC DEATH
  • LIVER-TRANSPLANTATION
  • MACHINE PERFUSION
  • COLD-STORAGE
  • IN-SITU
  • ARREST
  • PRESERVATION
  • EXPERIENCE

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