The Implications of the Shift Toward Donation After Circulatory Death in Australia

Reiling, Janske; Forrest, Elizabeth; Bridle, Kim R.; Britton, L.; Santrampurwala, Nishreen; Crawford, Darrell H. G.; Dejong, Cornelis H. C.; Fawcett, Jonathan

doi:10.1097/txd.0000000000000743

Cited by 10 publications

(9 citation statements)

References 22 publications

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“…Organ donation has steadily increased over the past few years and this is in part attributable to a rise in DCD donor numbers 1,17,18 . Many potential DCD donors are not recognised in Australia 19 and healthcare practitioners' understanding and attitudes towards this practice may play a role [11][12][13] .…”

Section: Discussionmentioning

confidence: 99%

Attitudes and Self-Reported End-Of-Life Care of Australian and New Zealand Intensive Care Doctors in the Context of Organ Donation after Circulatory Death

Lee

Ranse

Silvester

et al. 2018

Anaesth Intensive Care

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The incidence of organ donation after circulatory death (DCD) in Australia and New Zealand (ANZ) has steadily increased in recent years. Intensive care doctors are vital to the implementation of DCD and healthcare professionals’ attitudes to DCD can influence their participation. In order to determine ANZ intensive care doctors’ attitudes to DCD, to explore if demographic characteristics influence attitude to DCD and to assess if attitude to DCD can predict palliative prescription rationale at the end of life of DCD donors, a cross-sectional online survey was distributed to ANZ intensive care doctors and responses collected between 29 April and 10 June 2016. Exploratory factor analysis was used to define various attributes of attitude to DCD. Results were subjected to comparative statistical analyses to examine the relation between demographic data and attitude to DCD. Multiple regression models were used to examine if attitude to DCD could predict intensive care doctors’ palliative prescription rationales at the end of life of DCD donors. One hundred and sixty-one intensive care doctors responded to the survey with 69.4% having worked in intensive care for ten years or more. Respondents responded positively to the support of and perceived importance of DCD in helping those who would benefit from the donations (constructive attributes) (mean composite factor score = 3.84, standard deviation [SD] 0.83), they positively perceived that conducive and facilitative orchestration of DCD helps families cope (mean composite factor score = 3.94, SD 0.72) and that they would manage a DCD donor similar to any patient at the end of their life (mean score = 3.94, SD 0.72). Respondents responded negatively to having concerns that the circulatory death of potential DCD donors does not occur within the specified time frame (mean score = 2.28, SD 1.02). There was an association between organ donation professional education courses, familiarity with national guidelines and positive attitudes to certain attributes of attitude to DCD. Regression models demonstrated the attitude to DCD may predict intensive care doctors’ palliative medication prescription rationales at the end of life of the DCD donor. Intensive care doctors in ANZ adopt a morally neutral attitude to DCD where they recognise the importance of organ donation, and support and conduct DCD as a part of good end-of-life care.

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Section: Discussionmentioning

confidence: 99%

Attitudes and Self-Reported End-Of-Life Care of Australian and New Zealand Intensive Care Doctors in the Context of Organ Donation after Circulatory Death

Lee

Ranse

Silvester

et al. 2018

Anaesth Intensive Care

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“…(17) Our early results show that NMP can safely increase the utilization rate. (18) In the preclinical study, 7 (70%) discarded livers showed favorable metabolic and perfusion characteristics. Subsequently, post-SCS NMP was applied to preserve and assess 10 orphan livers, all of which were successfully transplanted with 100% 6-month graft and patient survival.…”

Section: Discussionmentioning

confidence: 99%

Assessment and Transplantation of Orphan Donor Livers: A Back‐to‐Base Approach to Normothermic Machine Perfusion

et al. 2020

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Globally, a large proportion of donor livers are discarded due to concerns over inadequate organ quality. Normothermic machine perfusion (NMP) allows for hepatocellular and biliary viability assessment prior to transplantation and might therefore enable the safe use of these orphan donor livers. We describe here the first Australasian experience of NMP-preserved liver transplants using a 'backto-base' approach, where NMP was commenced at the recipient hospital following initial static cold storage. In the preclinical phase, 10 human donor livers declined for transplantation (7 from donation after circulatory death [DCD] and 3 from donation after brain death [DBD]) were perfused using a custom-made NMP setup. Subsequently, 10 orphan donor livers (5 from DCD and 5 from DBD) underwent NMP and viability assessment on the OrganOx metra device (OrganOx Limited, Oxford, United Kingdom). Both hepatocellular and biliary viability criteria were used. The median donor risk index was 1.53 (1.16-1.71), and the median recipient Model for End-Stage Liver Disease score was 17 (11-21). In the preclinical phase, 'back-to-base' NMP was deemed suitable and feasible. In the clinical phase, each graft met predefined criteria for implantation during NMP and was subsequently transplanted. Five (50%) recipients developed early allograft dysfunction based on peak aspartate aminotransferase. To date, all grafts function satisfactorily, and none of the 5 recipients who received a DCD liver have developed cholangiopathy. The OrganOx metra using a backto-base approach has enabled the safe use of 10 high-risk orphan donor livers with 100% 6-month patient and graft survival. NMP improved surgeon confidence to use orphan donor livers and has enabled a safe expansion of the donor pool.

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“…Currently, most programs offer ECD organs to potential recipients disadvantaged by current allocation policy. (1,2) SCS reduces an organ's metabolic activity. The resulting oxygen level compromises mitochondrial metabolism with an accumulation of toxic metabolites.…”

Section: See Article On Page 1618mentioning

confidence: 99%

The Rise of the Machines: Will They Fulfill the Restoration Promise?

et al. 2020

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The Implications of the Shift Toward Donation After Circulatory Death in Australia

Cited by 10 publications

References 22 publications

Attitudes and Self-Reported End-Of-Life Care of Australian and New Zealand Intensive Care Doctors in the Context of Organ Donation after Circulatory Death

Attitudes and Self-Reported End-Of-Life Care of Australian and New Zealand Intensive Care Doctors in the Context of Organ Donation after Circulatory Death

Assessment and Transplantation of Orphan Donor Livers: A Back‐to‐Base Approach to Normothermic Machine Perfusion

The Rise of the Machines: Will They Fulfill the Restoration Promise?

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