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. 2022 Jun 6;12(1):48.
doi: 10.1186/s13613-022-01023-7.

Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

M Renaudier  1   2 , Y Binois  1   2 , F Dumas  1   2   3   4 , L Lamhaut  1   2   4   5 , F Beganton  1   2 , D Jost  1   2   6 , J Charpentier  7 , O Lesieur  4   8 , E Marijon  1   2   4   9 , X Jouven  1   2   4   9 , A Cariou  10   11   12   13 , W Bougouin  1   2   14 ; Paris Sudden Death Expertise Center group
Collaborators, Affiliations

Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

M Renaudier et al. Ann Intensive Care. .

Abstract

Background: Organ shortage is a major public health issue, and patients who die after out-of-hospital cardiac arrest (OHCA) could be a valuable source of organs. Here, our objective was to identify factors associated with organ donation after brain death complicating OHCA, in unselected patients entered into a comprehensive real-life registry covering a well-defined geographic area.

Methods: We prospectively analyzed consecutive adults with OHCA who were successfully resuscitated, but died in intensive care units in the Paris region in 2011-2018. The primary outcome was organ donation after brain death. Independent risk factors were identified using logistic regression analysis. One-year graft survival was assessed using Cox and log-rank tests.

Results: Of the 3061 included patients, 136 (4.4%) became organ donors after brain death, i.e., 28% of the patients with brain death. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, factors associated with organ donation were neurological cause of OHCA (odds ratio [OR], 14.5 [7.6-27.4], P < 0.001), higher pH (OR/0.1 increase, 1.3 [1.1-1.6], P < 0.001); older age was negatively associated with donation (OR/10-year increase, 0.7 [0.6-0.8], P < 0.001). In patients without post-resuscitation shock, the factor associated with donation was neurological cause of OHCA (OR, 6.9 [3.0-15.9], P < 0.001); higher pH (OR/0.1 increase, 0.8 [0.7-1.0], P = 0.04) and OHCA at home (OR, 0.4 [0.2-0.7], P = 0.006) were negatively associated with organ donation. One-year graft survival did not differ according to Utstein characteristics of the donor.

Conclusions: 4% of patients who died in ICU after OHCA led to organ donation. Patients with OHCA constitute a valuable source of donated organs, and special attention should be paid to young patients with OHCA of neurological cause.

Keywords: Brain death; Epidemiology; Organ donation; Out-of-hospital cardiac arrest.

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Conflict of interest statement

None of the authors has any disclosures.

Figures

Fig. 1
Fig. 1
Patient flowchart. ICU: intensive care unit; OHCA: out-of-hospital cardiac arrest
Fig. 2
Fig. 2
Process from brain death to organ donation
Fig. 3
Fig. 3
Graft survival from donors with brain death after out-of-hospital cardiac arrest
Fig. 4
Fig. 4
Significant independent predictors of organ donation in patients with and without post-resuscitation shock. Only patients without missing data were included; 95% CI: 95% confidence interval; OHCA: out-of-hospital cardiac arrest; OR: odds ratio
See this image and copyright information in PMC

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