Development of the University of Wisconsin Donation After Cardiac Death Evaluation Tool

Abstract

Using the University of Wisconsin Donation After Cardiac Death Evaluation Tool, we were able to predict suitability for donation after cardiac death 83.7% of the time, within a 60-minute period and 74.4% of the time within a 120-minute period. The actual results using the tool were higher when clinical observations were included in the donation after cardiac death evaluation--an overall accuracy of 88.4%.

Predicting time to death after withdrawal of life-sustaining therapy

“…1). Fifteen observational studies fulfilled our inclusion criteria, 13 of which evaluated an adult population and two a pediatric population [1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19]. In all studies, with one exception [2], time to death as an outcome was dichotomized.…”

“…In all studies, with one exception [2], time to death as an outcome was dichotomized. Time of death within 60 min was the primary outcome in 13 of the 15 included studies, with assessments of 5173 patients [6][7][8][9][10][11][12][13][14][15][16][17][18]. Three studies additionally evaluated time to death within 120 min [6,12,14].…”

“…Time of death within 60 min was the primary outcome in 13 of the 15 included studies, with assessments of 5173 patients [6][7][8][9][10][11][12][13][14][15][16][17][18]. Three studies additionally evaluated time to death within 120 min [6,12,14]. Two studies evaluated factors associated with time to death without specifying a time cutoff [2,19], one study included time to death within 30 min [13], and one study included time to death within 10 h [10].…”

“…DCD potential according to DeVita et al[7]: DCD subgroup, age \60 years, creatinine \2 mg/dL, no overwhelming sepsis. DCD potential according to Lewis et al[6]: severe brain injury receiving mechanical ventilation for whom a physician is evaluating for brain death with a Glasgow Coma Score (GCS) of \5, Not all papers included a detailed overview of the components withdrawn or methods of withdrawal; therefore the components and methods of withdrawal may not be limited to the lists above e DCD subgroup of cohort included in the study of Brieva et al[11] (2013)Note: for adult studies, the median age for death in given in years; for pediatric studies, median age for death is as indicated. Data are presented as median age for time to death within 60 min, followed by median age for time to death of [60…”

How I Manage the Adult Potential Organ Donor: Donation After Cardiac Death (Part 2)

“…Typically, relative ischemia or hypoxia that continues for more than 1 h after withdrawal of life-sustaining therapy will render organs unusable for donation. An approximation of the time from ventilator withdrawal to cardio-pulmonary arrest can be achieved by implementing the University of Wisconsin tool for predicting asystole after withdrawal of life support (Table 1) [12]. To perform the assessment, the patient is disconnected from the ventilator for 10 min and respiratory and hemodynamic functions are assessed.…”