Clinical results of an organ procurement organization effort to increase utilization of donors after cardiac death.
BACKGROUND
To stimulate organ donation, an organ procurement organization (OPO)-wide effort was undertaken to increase donors after cardiac death (DCD) over a 5-year period. This included commonality of protocols, pulsatile perfusion of kidneys, centralization of data and a regional allocation variance designed to minimize cold ischemia times and encourage adoption of DCD protocols at transplant centers.


RESULTS
In one OPO, eight centers initiated DCD programs in 11 hospitals. A total of 52 DCD donors were procured, increasing from four in 1999 to 21 in 2003. Eleven donors had care withdrawn in the operating room, whereas 41 had care withdrawn in the ICU. In all, 91 patients received renal transplants from these 52 donors (12 kidneys discarded, one double transplant), whereas 5 patients received liver transplants. One-, two-, and three-year kidney graft survival rates were 90%, 90%, and 82%, respectively. Fifty-five percent of patients needed at least one session of hemodialysis postoperatively. Mean recipient hospital length of stay was 11.1+/-6 days. Mean creatinine levels at 3, 6, 12, and 24 months were 1.65, 1.40, 1.41, and 1.40, respectively.


CONCLUSIONS
DCD donors can be an important source of donor organs and provide excellent overall outcomes. Regional cooperation and a prospectively considered allocation and distribution system are important considerations in stimulating DCD programs.
Whiting
James F
JF
Department of Surgery, Maine Medical Center, Portland, 04102, USA. whitij@mmc.org
Delmonico
Francis
F
Morrissey
Paul
P
Basadonna
Giacomo
G
Johnson
Scott
S
Lewis
W David
WD
Rohrer
Richard
R
O'Connor
Kevin
K
Bradley
James
J
Lovewell
Tammy D
TD
Lipkowitz
George
G
D000328:Adult; D003643:Death; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008875:Middle Aged; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data