title: Organ donation after cardiac death: donor and recipient outcomes after the first three years of the Ontario experience.
abstract: OBJECTIVE
  The aim of this study was to explore donor and recipient outcomes from organ donation after cardiac death (DCD) in Ontario and to examine the impact of DCD on deceased donation rates in Ontario since its implementation.
  
  
  METHODS
  Donor data were obtained from the Trillium Gift of Life Network (TGLN) TOTAL database from June 1, 2006 until May 31, 2009. All DCDs were tracked, including unsuccessful DCD attempts during that time. For the first 36 months after DCD implementation, all Ontario solid organ transplant programs that utilized organs from DCD provided clinical outcome data at one year. Total DCD activity until December 1, 2010 was also tracked. In addition, we compared organ donation and DCD rates across all Canadian jurisdictions and the USA.
  
  
  RESULTS
  For the first 36 months of DCD activity in Ontario, June 1, 2006 to May 31, 2009, there were 67 successful DCDs out of 87 attempted DCDs in 18 Ontario hospitals, resulting in 128 kidney, 41 liver, and 21 lung transplants. The one-year kidney patient and death-censored allograft survivals were 96 and 97%, respectively. Mean (SD) creatinine at 12 months was 150 (108) μmol·L(-1). In 26 (20%) extended criteria donors (ECD-DCD), the one-year creatinine was 206 (158) μmol·L(-1) vs 137 (80) μmol·L(-1) in 102 standard criteria donors (SCD-DCD) (P = 0.002). The one-year liver and lung allograft survivals were 78% and 70%, respectively. Since its implementation four and a half years ago, DCD has accounted for 10.9% of deceased donor activity in Ontario. In 2009, Ontario had a record number of organ donors. Of the 221 deceased donors, 37 (17%) donors were DCD. By December 1, 2010 there were 121 DCD Ontario donors resulting in > 300 solid organ transplants and accounting for 90% of all DCD activity in the country.
  
  
  CONCLUSIONS
  The rapid update of DCD in Ontario can be attributed to strong proponents in the critical care and transplantation communities with continued support from Trillium Gift of Life Network (TGLN). Ontario is the only province to demonstrate growth in deceased donor rates over the last decade (25% over the last four years), which can be attributed primarily to the success of its DCD activity.
authors.affiliation: Multi-Organ Transplant Program, London Health Science Centre, London, ON, Canada.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernadez-Alejandro
authors.affiliation: Multi-Organ Transplant Program, London Health Science Centre, London, ON, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Wall
authors.affiliation: Multi-Organ Transplant Program, London Health Science Centre, London, ON, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Jevnikar
authors.affiliation: Multi-Organ Transplant Program, London Health Science Centre, London, ON, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Luke
authors.affiliation: Department of Critical Care, London Health Science Centre, London, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
authors.affiliation: Division of Nephrology, Department of Medicine, St. Joseph's Hospital, Hamilton, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Russell
authors.affiliation: Division of Nephrology, Department of Medicine, St. Joseph's Hospital, Hamilton, ON, Canada.
authors.forename: Azeem
authors.initials: A
authors.lastname: Gangji
authors.affiliation: Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Cole
authors.affiliation: Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
authors.forename: Sang Joseph
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
authors.forename: Marcus
authors.initials: M
authors.lastname: Selzner
authors.affiliation: Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: Kidney Transplant Program, Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Dianne
authors.initials: D
authors.lastname: Hebert
authors.affiliation: Division of Nephrology, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: G V Ramesh
authors.initials: GVR
authors.lastname: Prasad
authors.affiliation: Department of Anesthesia, Li Ka Shing Knowledge Institute, Cara Phelan Centre for Trauma Research, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Baker
authors.affiliation: Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Knoll
authors.affiliation: University of Ottawa Medical School, Ottawa, ON, USA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Winterbottom
authors.affiliation: Department of Critical Care, The Ottawa Hospital, Ottawa, ON, USA.
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Pagliarello
authors.affiliation: Trillium Gift of Life Network, Toronto, ON, Canada.
authors.forename: Clare
authors.initials: C
authors.lastname: Payne
authors.affiliation: Trillium Gift of Life Network, Toronto, ON, Canada. jeffrey.zaltzman@utoronto.ca.|Division of Nephrology, Department of Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 61 Queen St. East, Room 9-118, Toronto, ON, M5C 2T2, Canada. jeffrey.zaltzman@utoronto.ca.
authors.forename: Jeff
authors.initials: J
authors.lastname: Zaltzman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D003643:Death; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D016040:Lung Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult