Experience With a New Process—Condition T—for Uncontrolled Donation After Circulatory Determination of Death in a University Emergency Department

Abstract

It is feasible to create a process to rapidly intervene in the ED for uDCD. However, no organ transplants resulted. The utility and sustainability of an uDCD program in this particular setting are questionable.

Initial lung transplantation experience with uncontrolled donation after cardiac death in North America

“…In this specific study, of 502 potential donors, 31 lungs were recovered—only 2 of those were considered transplantable but were ultimately not used due to the absence of an eligible recipient (n = 1) and the unavailability of a transplant surgeon (n = 1) . Similarly, despite extensive protocols developed for uDCD practices in New York, no lung transplants have been performed in that state using this donor type …”

The unique moral permissibility of uncontrolled lung donation after circulatory death

“…Pittsburgh that used opt-in frameworks. 6,7 In NYC, government and community stakeholders established an out-of-hospital uDCDD program for cases when termination of resuscitation (TOR) decisions occurred in private residences ( 9 Mechanical ventilation post mortem was used for initial lung preservation. Lungs were recovered from 31 donors.…”

“…12,22 Previous uDCDD programs in the United States have relied on registered donors to avoid the challenge of obtaining authorization quickly enough for organ preservation, and have largely failed because of insufficient enrollment. 6,8,9 The National Academy of Medicine originally advocated for presumed authorization for organ preservation in uDCDD citing the success of European protocols, but has since backed away from this position, but lungs are unique.…”

“…6,7 In NYC, government and community stakeholders established an out-of-hospital uDCDD program for cases when termination of resuscitation (TOR) decisions occurred in private residences ( 9 Mechanical ventilation post mortem was used for initial lung preservation. 6,7 In NYC, government and community stakeholders established an out-of-hospital uDCDD program for cases when termination of resuscitation (TOR) decisions occurred in private residences ( 9 Mechanical ventilation post mortem was used for initial lung preservation.…”

“…28 Some authorities have questioned the requirement for "no-touch" periods, given the movement towards brain-based definitions of death with events preceding auto-resuscitation and its duration being inadequate to reverse the pending permanent and irreversible loss of brain function. 6,8,9 The National Academy of Table 2 and protocol timeline in The potential donor has registered intentions to donate: After life-saving measures have been performed and determined futile to continue, a separate team will begin lung preservation efforts after a 5-10-minute "no-touch" period has elapsed and registered intentions are discovered. Given prudence, uDCDD lung protocols should follow a 5-10-minute "no-touch" period after TOR decisions are made to fulfill permanence/irreversibility criteria with timing considerations based on cultural norms and standard practice.…”