title: Experience With a New Process - Condition T - for Uncontrolled Donation After Circulatory Determination of Death in a University Emergency Department.
abstract: BACKGROUND
  In the United States, organ donation after circulatory death (DCD) determination is increasing among those who are removed from life-sustaining therapy but is rare when death is unexpected. We created a program for uncontrolled DCD (uDCD).
  
  
  METHODS
  A comprehensive program was created to train personnel to identify and respond quickly to potential donors after unexpected death. The process termed Condition T was implemented in the emergency department (ED) of 2 academic medical centers. All ED deaths were screened for uDCD potential. Eligible donors included patients with preexisting donor designation who received cardiopulmonary resuscitation, failed to respond, and were pronounced dead.
  
  
  RESULTS
  Over 350 nurses, physicians, perfusionists, organ procurement personnel, and administrators were trained. From February 2009 to June 2010, a total of 18 patients were potential Condition T candidates. Six Condition T responses were triggered. Three donors underwent cannulation, and 4 organs were recovered (3 kidney and 1 liver) from 2 donors. Time from Condition T trigger to perfusion with organ preservation solution ranged from 14 to 22.3 minutes. Perfusion duration was 197 and 221 minutes. No recovered organs were transplanted because biopsies showed prolonged warm ischemia.
  
  
  CONCLUSIONS
  It is feasible to create a process to rapidly intervene in the ED for uDCD. However, no organ transplants resulted. The utility and sustainability of an uDCD program in this particular setting are questionable.
authors.affiliation: Harlem Hospital Center, New York, NY, USA michael.devita@nychhc.org.
authors.forename: Michael A
authors.initials: MA
authors.lastname: DeVita
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA UPMC Presbyterian Hospital, Pittsburgh, PA, USA.
authors.forename: Charissa
authors.initials: C
authors.lastname: Pacella
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
authors.forename: Maria Mori
authors.initials: MM
authors.lastname: Brooks
authors.affiliation: Winter Institute for Simulation Education and Research, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lutz
authors.affiliation: Center for Organ Recovery and Education, Pittsburgh, PA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Stuart
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006282:Health Personnel / Q000193:education / Q000458:organization & administration*; D006323:Heart Arrest; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods / Q000458:organization & administration*; D052096:Warm Ischemia
keywords: donation after circulatory determination of death; organ donation; organ transplantation