Effect of organ donation after circulatory determination of death on number of organ transplants from donors with neurologic determination of death

Abstract

To increase the available pool of organ donors, Ontario introduced donation after circulatory determination of death (DCD) in 2006. Other jurisdictions have reported a decrease in donations involving neurologic determination of death (NDD) after implementation of DCD, with a drop in organ yield and quality. In this study, we examined the effect of DCD on overall transplant activity in Ontario. . We compared these donor groups by categorical characteristics. RESULTS: Donation increased by 57%, from 578 donors in the pre-DCD era to 905 donors in the recent DCD era, with a 21% proportion (190/905) of DCD donors in the recent DCD era. However, overall NDD donation also increased. The mean length of hospital stay before declaration for NDD was 2.7 days versus 6.0 days before withdrawal of life support and subsequent asystole in cases of DCD. The average organ yield was 3.73 with NDD donation versus 2.58 with DCD (p < 0.001). Apart from hearts, all organs from DCD donors were successfully transplanted. From the pre-DCD era to the recent DCD era, transplant activity in each era increased for all solid-organ recipients, including heart (from 158 to 216), kidney (from 821 to 1321), liver (from 477 to 657) and lung (from 160 to 305).INTERPRETATION: Implementation of DCD in Ontario led to increased transplant activity for all solid-organ recipients. There was no evidence that the use of DCD was pre-empting potential NDD donation. In contrast to groups receiving other organs, heart transplant candidates have not yet benefited from DCD.

Missed opportunities for DCD kidney donors: Evaluation of warm ischemic time and associated functional warm ischemic time

“…Donation after circulatory determination of death (DCD) has been adopted as a method to expand the critical shortage of available kidney allografts . Since DCD was introduced in Ontario, Canada, in 2006, over 20% of all transplants in the province are currently DCD and represent the fastest growing form of organ donation in Canada…”

Development of a multinational registry of pediatric deceased organ donation activity

“…Whatever the cause of the described variable pDCD rates, it will be important for stakeholders to explore means of improving pDCD performance. The role of DCD implementation in driving increases in donation activity has been well documented in the adult donation literature, and the data from this registry suggest potential for improvement in pediatric practice.…”

Enhanced myocardial protection in cardiac donation after circulatory death using Intralipid® postconditioning in a porcine model

“…In fact, there is a growing contribution of DCD organ donations (e.g., kidney and liver) to transplant rates in Canada. 1 Nevertheless, in other jurisdictions such as Australia, New Zealand, and the United Kingdom, DCD heart transplantation is only beginning to be used clinically. 2 Ischemia-reperfusion (IR) injury is a major problem in cardiac transplantation, 3 specifically in the DCD context, 4 where interventions to reduce IR injury can only be initiated at the time of organ procurement (and after cardiac arrest).…”