title: Organ donation after circulatory death in a university teaching hospital.
abstract: Although organ transplantation is well established for end-stage organ failure, many patients die on waiting lists due to insufficient donor numbers. Recently, there has been renewed interest in donation after circulatory death (DCD). In a retrospective observational study we reviewed the screening of patients considered for DCD between March 2007 and December 2012 in our hospital. Overall, 148 patients were screened, 17 of whom were transferred from other hospitals. Ninety-three patients were excluded (53 immediately and 40 after review by donation staff). The 55 DCD patients were younger than those excluded (P=0.007) and they died from hypoxic brain injury (43.6%), intraparenchymal haemorrhage (21.8%) and subarachnoid haemorrhage (14.5%). Antemortem heparin administration and bronchoscopy occurred in 50/53 (94.3%) and 22/55 (40%) of cases, respectively. Forty-eight patients died within 90 minutes and proceeded to donation surgery. Associations with not dying in 90 minutes included spontaneous ventilation mode (P=0.022), absence of noradrenaline infusion (P=0.051) and higher PaO2:FiO2 ratio (P=0.052). The number of brain dead donors did not decrease over the study period. The time interval between admission and death was longer for DCD than for the 45 brain dead donors (5 [3-11] versus 2 [2-3] days; P<0.001), and 95 additional patients received organ transplants due to DCD. Introducing a DCD program can increase potential organ donors without reducing brain dead donors. Antemortem investigations appear to be acceptable to relatives when included in the consent process.
authors.affiliation: Anaesthesia Research Coordinator, Austin Health, ANZCA Clinical Trials Network Coordinator, Monash University, Melbourne, Victoria.
authors.forename: S
authors.initials: S
authors.lastname: Sidiropoulos
authors.affiliation: Organ Donor Coordinator, DonateLife Victoria, Victoria.
authors.forename: E
authors.initials: E
authors.lastname: Treasure
authors.affiliation: Director, Respecting Patient Choices, Medical Consultant, DonateLife Victoria, Adjunct Associate Professor, University of Melbourne, Victoria, Adjunct Associate Professor, University of Sydney, NSW.
authors.forename: W
authors.initials: W
authors.lastname: Silvester
authors.affiliation: Director of Intensive Care, Warringal Private Hospital, Victoria, National Medical Director, Organ and Tissue Authority, Canberra, ACT.
authors.forename: H
authors.initials: H
authors.lastname: Opdam
authors.affiliation: Deputy Director of Intensive Care and Medical Donation Specialist, Austin Health, Director of Intensive Care, Epworth Eastern Private Hospital, Senior Lecturer and Research Fellow, The University of Melbourne, Melbourne, Victoria.
authors.forename: S J
authors.initials: SJ
authors.lastname: Warrillow
authors.affiliation: A/Prof, Department of Epidemiology and Preventive Medicine, Monash University, Consultant Intensive Care Specialist, Austin Health, Adjunct Associate Professor, University of Melbourne, Medical Director Critical Care Outreach, Austin Hospital, Victoria.
authors.forename: D
authors.initials: D
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death; D005260:Female; D006323:Heart Arrest; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement
keywords: donation after cardiac death; donation after circulatory death; organ donation