ORGAN DONATION AND ALLOCATION II

D.M. Summers¹, C. Counter², J.A. Bradley³, J. Neuberger^4
1Department Of Surgery, University of Cambridge, Cambridge/UNITED KINGDOM, ²Statistics And Clinical Audit, NHS Blood and Transplant (UK), Bristol/UNITED KINGDOM, ³Transplant Surgery, Addenbrooke's Hospital NHS Trust, Cambridge/UNITED KINGDOM, ⁴, NHS Blood and Transplant, Bristol/UNITED KINGDOM

Body: Introduction Organ donation after cardiac death (DCD) is becoming more common in the UK but DCD donors provide fewer usable organs than donors with brain death (DBD) and recipients of DCD organs may experience more complications. There have been anecdotal reports of potential DBD donors becoming DCD donors but the extent of this practice is unknown. Methods A comprehensive analysis of all patients who became solid organ donors in the UK between April 1999 and March 2009 was performed to identify trends in donor characteristics. Data from a prospective audit of all patients under 76 years who died in non-cardiothoracic intensive care units in the UK between April 2003 and March 2009, were analysed to determine whether the increase in DCD donation may be due to a conversion of potential DBD donors to DCD donors. Results Over the last decade, the annual number of deceased donors (DD) increased by 16% from 777 in 1999/2000 to 900 in 2008/9. The increase is due exclusively to an increase in DCD donation with an almost 8-fold increase in DCD donors from 33 in 1999/2000 to 288 in 2008/9. Over the same time period, DBD donation has fallen 13% from 714 to 622 donors per year. For both DBD and DCD donors the proportion of ‘expanded criteria donors’ (Port et al. 2002) has increased markedly from 18% to 27%. DD are now less likely to have died of trauma (22% in 1999/2000 and 11% in 2008/9) and more likely to be overweight (BMI>25) (39% versus 54%). Over the five year period 2004/5 to 2008/9, the number of deaths in ITU fell by 5% from 16389 to 15516. Over the same period, potential DBD donors (i.e. those with confirmed brain death (BD) and no medical contraindication) declined from a total of 1333 to 1135 (15%). The number of potential DCD donors fluctuated over the period with 1425 identified in 2008/9 but the conversion rate of potential donors into actual donors increased for both DBD and DCD donors with a conversion rate increase of 6 percentage points to 51% and 11 percentage points to 16% for DBD and DCD donors, respectively. The percentage of patients in whom BD was possible who were not formally assessed for BD fell from 31% to 22%, suggesting that there is unlikely to be a large number of DCD donors who could have become DBD donors. Conclusion The number of potential DBD donors has fallen over the past decade and, despite transplant centres’ willingness to use more marginal organs, the number of actual DBD donors has also declined. DCD donor numbers have increased markedly but there appears little evidence from this analysis that significant numbers of potential DBD donors becoming DCD donors.

Disclosure: All authors have declared no conflicts of interest.