title: When Do DCD Donors Die?: Outcomes and Implications of DCD at a High-volume, Single-center OPO in the United States.
abstract: OBJECTIVE
  The objective of this study was to determine the fate of patients who attempted to donate organs after circulatory death (DCD) using a standardized DCD protocol.
  
  
  BACKGROUND
  Successful donation is not always possible after attempted DCD.
  
  
  METHODS
  Data were collected for all DCD donors between 1/2011 and 9/2014. DCDs were carried out using a uniform protocol at a single-center organ procurement organization.
  
  
  RESULTS
  During the timeframe considered, DCD donation was attempted in 169 patients. In 46 patients (27.2%), no organs were recovered because the patients did not die within 2 hours. Successful donation was more likely if withdrawal of support occurred in the operating room versus the intensive care unit (P = 0.006). Time from extubation to death was available for 161/169 donors (95.3%). Of 161 donors, 111 (66.9%) died in under 1 hour. The mean time from withdrawal of support to patient death for unsuccessful donations was 33 hours, 37 minutes (range, 24 minutes-242 hours) versus 29 minutes (range, 5 minutes-2 hours, 4 minutes) for successful donations. Twenty-seven patients who unsuccessfully donated (67.5%) died within 24 hours. Were unsuccessful donations converted to successful donations, as many as 837 abdominal transplants could have been carried out in the United States, during the study period.
  
  
  CONCLUSIONS
  DCD is an important form of organ donation. A large number of abdominal transplants are not possible due to unsuccessful DCD organ donation. It may be useful to explore DCD donor family satisfaction to identify other options for improving DCD donation.
authors.affiliation: *Division of Transplantation, Department of Surgery, University of Wisconsin, Madison, WI †University of Wisconsin Organ and Tissue Donation (UWOTD), Madison, WI.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Scalea
authors.forename: Robert R
authors.initials: RR
authors.lastname: Redfield
authors.forename: Michael D
authors.initials: MD
authors.lastname: Rizzari
authors.forename: Ryan
authors.initials: R
authors.lastname: Bennett
authors.forename: Michael E
authors.initials: ME
authors.lastname: Anderson
authors.forename: James E
authors.initials: JE
authors.lastname: Anderson
authors.forename: Dixon B
authors.initials: DB
authors.lastname: Kaufman
authors.forename: Hans W
authors.initials: HW
authors.lastname: Sollinger
authors.forename: Luis A
authors.initials: LA
authors.lastname: Fernandez
authors.forename: Anthony M
authors.initials: AM
authors.lastname: D'Alessandro
authors.forename: Joshua
authors.initials: J
authors.lastname: Mezrich
mesh_terms: D000328:Adult; D003643:Death; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008020:Life Support Care; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States; D028761:Withholding Treatment