title: Lesson From the New York City Out-of-Hospital Uncontrolled Donation After Circulatory Determination of Death Program.
abstract: OBJECTIVE
  In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement.
  
  
  METHODS
  We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods.
  
  
  RESULTS
  The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%).
  
  
  CONCLUSIONS
  In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.
authors.affiliation: Bellevue Hospital Center, New York, NY; Department of Emergency Medicine, NYU School of Medicine, New York, NY.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Wall
authors.affiliation: Fire Department of the City of New York, New York, NY, and the Department of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Kaufman
authors.affiliation: Department of Emergency Medicine, NYU School of Medicine, New York, NY.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Williams
authors.affiliation: NYU Steinhardt School of Culture, Education, and Human Development, New York, NY.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Norman
authors.affiliation: MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Gilbert
authors.affiliation: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Munjal
authors.affiliation: Department of Emergency Medicine, NYU School of Medicine, New York, NY.
authors.forename: Shana
authors.initials: S
authors.lastname: Maikhor
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldstein
authors.affiliation: LiveOnNY, New York, NY (formerly the New York Organ Donor Network).
authors.forename: Julia E
authors.initials: JE
authors.lastname: Rivera
authors.affiliation: LiveOnNY, New York, NY (formerly the New York Organ Donor Network).
authors.forename: Harvey
authors.initials: H
authors.lastname: Lerner
authors.affiliation: Bellevue Hospital Center, New York, NY; Department of Emergency Medicine, NYU School of Medicine, New York, NY.
authors.forename: Chad
authors.initials: C
authors.lastname: Meyers
authors.affiliation: Bellevue Hospital Center, New York, NY; Department of Emergency Medicine, NYU School of Medicine, New York, NY.
authors.forename: Marion
authors.initials: M
authors.lastname: Machado
authors.affiliation: Bellevue Hospital Center, New York, NY; Department of Emergency Medicine, NYU School of Medicine, New York, NY.
authors.forename: Susan
authors.initials: S
authors.lastname: Montella
authors.affiliation: Bellevue Hospital Center, New York, NY.
authors.forename: Marcy
authors.initials: M
authors.lastname: Pressman
authors.affiliation: Department of Surgery, NYU School of Medicine, New York, NY; NYU Organ Transplant Center, NYU School of Medicine, New York, NY.
authors.forename: Lewis W
authors.initials: LW
authors.lastname: Teperman
authors.affiliation: Department of Population Health, Division of Medical Ethics, NYU School of Medicine, New York, NY.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Dubler
authors.affiliation: Bellevue Hospital Center, New York, NY; Department of Emergency Medicine, NYU School of Medicine, New York, NY. Electronic address: lewis.goldfrank@nyumc.org.
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Goldfrank
mesh_terms: D055812:Community-Based Participatory Research; D003643:Death; D004632:Emergency Medical Services; D006801:Humans; D007258:Informed Consent; D016030:Kidney Transplantation; D009519:New York City; D058687:Out-of-Hospital Cardiac Arrest; D010865:Pilot Projects; D011446:Prospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000458:organization & administration*; D014850:Waiting Lists