RT Journal Article
SR Electronic
T1 Effect of organ donation after circulatory determination of death on number of organ transplants from donors with neurologic determination of death
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1206
OP E1211
DO 10.1503/cmaj.161043
VO 189
IS 38
A1 Vivek Rao
A1 Sonny Dhanani
A1 Janet MacLean
A1 Clare Payne
A1 Elizabeth Paltser
A1 Atul Humar
A1 Jeffrey Zaltzman
YR 2017
UL http://www.cmaj.ca/content/189/38/E1206.abstract
AB BACKGROUND: To increase the available pool of organ donors, Ontario introduced donation after circulatory determination of death (DCD) in 2006. Other jurisdictions have reported a decrease in donations involving neurologic determination of death (NDD) after implementation of DCD, with a drop in organ yield and quality. In this study, we examined the effect of DCD on overall transplant activity in Ontario.METHODS: We examined deceased donor and organ transplant activity during 3 distinct 4-year eras: pre-DCD (2002/03 to 2005/06), early DCD (2006/07 to 2009/10) and recent DCD (2010/11 to 2013/14). We compared these donor groups by categorical characteristics.RESULTS: Donation increased by 57%, from 578 donors in the pre-DCD era to 905 donors in the recent DCD era, with a 21% proportion (190/905) of DCD donors in the recent DCD era. However, overall NDD donation also increased. The mean length of hospital stay before declaration for NDD was 2.7 days versus 6.0 days before withdrawal of life support and subsequent asystole in cases of DCD. The average organ yield was 3.73 with NDD donation versus 2.58 with DCD (p < 0.001). Apart from hearts, all organs from DCD donors were successfully transplanted. From the pre-DCD era to the recent DCD era, transplant activity in each era increased for all solid-organ recipients, including heart (from 158 to 216), kidney (from 821 to 1321), liver (from 477 to 657) and lung (from 160 to 305).INTERPRETATION: Implementation of DCD in Ontario led to increased transplant activity for all solid-organ recipients. There was no evidence that the use of DCD was pre-empting potential NDD donation. In contrast to groups receiving other organs, heart transplant candidates have not yet benefited from DCD.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.170988