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. 2021 Dec 23;8(1):e1263.
doi: 10.1097/TXD.0000000000001263. eCollection 2022 Jan.

Potential of Donation After Unexpected Circulatory Death Programs Defined by Their Demographic Characteristics

Aukje Brat  1 , Leonie H Venema  1 , Bas W J Bens  2 , Remy Stieglis  3 , Joris J van der Heijden  4 , Constantino Fondevila  5 , Oleg N Reznik  6 , Benoit Barrou  7 , Michiel E Erasmus  8 , Henri G D Leuvenink  1
Affiliations

Potential of Donation After Unexpected Circulatory Death Programs Defined by Their Demographic Characteristics

Aukje Brat et al. Transplant Direct. .

Abstract

Background: Donation after unexpected circulatory death (uDCD) donors are often suggested to increase the number of donor organs. In 2014, a uDCD protocol was implemented in three transplant centers in the Netherlands which unfortunately did not result in additional transplantations. This study was initiated to identify demographic factors influencing the potential success of uDCD programs.

Methods: Dutch resuscitation databases covering various demographic regions were analyzed for potential donors. The databases were compared with the uDCD implementation project and successful uDCD programs in Spain, France, and Russia.

Results: The resuscitation databases showed that 61% of all resuscitated patients were transferred to an emergency department. Age selection reduced this uDCD potential to 46% with only patients aged 18-65 years deemed eligible. Of these patients, 27% died in the emergency department. The urban region of Amsterdam showed the largest potential in absolute numbers (52 patients/y). Comparison with the uDCD implementation project showed large similarities in the percentage of potential donors; however, in absolute numbers, it showed a much smaller potential. Calculation of the potential per million persons and the extrapolation of the potential based on the international experience revealed the largest potential in urban regions.

Conclusions: Implementation of a uDCD program should not only be based on the number of potential donors calculated from resuscitation databases. They show promising potential uDCD percentages for large rural regions and small urban regions; however, actual numbers per hospital are low, leading to insufficient exposure rates. It is, therefore, recommendable to limit uDCD programs to large urban regions.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
The safety regions analyzed and their distribution in the Netherlands. ARREST, Amsterdam Resuscitation Study; uDCD, donation after unexpected circulatory death; UTOPIA, Utrecht Study Group for Optimal Registry of Cardiac Arrest.
FIGURE 2.
FIGURE 2.
Overview of the representation of data of different steps from OHCA to transplantation by the study sources used. ED, emergency department; OHCA, out-of-hospital cardiac arrest; uDCD, donation after unexpected circulatory death.
FIGURE 3.
FIGURE 3.
Flowchart of the steps following announcement of OHCA at the control center leading to potential uDCD donation. The dark blue box represents the patients who died in the emergency department, the so-called true potential. The patients who died before arrival at the hospital (light blue) could be potential uDCD when transferred to the hospital, and the patients who died after being admitted to the hospital are outside the scope of uDCD donation but could potentially be either donation after brain death or DCD donors. CCU, cardiac care unit; CPR, cardiopulmonary resuscitation; ICU, intensive care unit; OHCA, out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation; ROSV, return of spontaneous ventilation; uDCD, donation after unexpected circulatory death.
FIGURE 4.
FIGURE 4.
uDCD potential for all safety regions in the Netherlands. uDCD, donation after unexpected circulatory death.
See this image and copyright information in PMC

References

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