The impact of changing Donation after Cardiac Death criteria on available potential donors: a study of 22 Victorian hospitals

Hugh Stephens¹, David Pilcher², Helen Opdam³, Gregory Snell⁴, Jeffrey Rosenfeld⁵

¹MBBS/PhD Candidate, Monash University / The Alfred Hospital, Melbourne, Australia, ²Department of Intensive Care, Alfred Hospital, Melbourne, Australia, ³DonateLife Victoria, Melbourne, Australia, ⁴AIRmed Lung Transplant Service, Alfred Hospital, Melbourne, Australia, ⁵Department of Surgery, Alfred Hospital, Melbourne, Australia

Background

Australian Donation after Cardiac Death (DCD) protocol requires all potential donors to die within 90 minutes of withdrawal of life-sustaining therapy and be aged less than 65 years. International centres have reported favourable outcomes from donors outside this time limit [1] or from those older than 65 [2].

Methods

We analysed a database of 18,949 deaths in Victorian hospitals from 1 January 2010 to 30 June 2012 to determine the impact of adjusting these criteria on potential donor numbers. We defined a potential donor as a death in ED, ICU or operating theatre, ventilated in the 6 hours prior to death, not having active cancer, unlikely to become brain dead, and having a cardiorespiratory system supportable for long enough to facilitate donation.

Results

There were 257 potential DCD donors using existing parameters. 89% (n=228) died in ICU, 11% (n=27) in the emergency department and 2 in operating theatre. 42 (16%) subsequently donated organs. Increasing the maximum age limit to 70 would result in 71 additional potential donors, and a further 71 were aged 71-75 but were otherwise eligible. During the study period, 6 patients donated organs aged 67 to 72, so increasing formal age criteria to 70 or 75 may be already feasible in the Australian context.

339 deaths had time until death recorded with (aged under 65). 51% (n=184) died within 30 minutes, 14% (n=52) within 60 and 5.8% (n=21) within 90 minutes (i.e. matched existing criteria). Increasing the time limit to 120 minutes could provide an additional 11 donors, or 150 minutes a further 18 donors.

Conclusions

Modifying age criteria appears to have the most significant impact on increasing the number of potential DCD donors, while modifying time to death having a minor effect.