UNEXPECTED DONATION AFTER CIRCULATORY DEATH (UDCD) - A GREAT POTENTIAL FOR NEW ORGANS?

The number of patients waiting for a transplant exceeds the number of donor organs suitable for transplantation. Therefore, the search for new organ sources continues. uDCD donors are patients that died as result of an out of hospital cardiac arrest (OHCA). They are scarcely used in the Netherlands as a source of organ grafts. A possible reason for the minimal use of this donor type is the complexity of the protocol in terms of logistics. Three transplant centres in the Netherlands started a pilot with the aim to assess the uDCD donor potential. The innovative part of the pilot was the use of normothermic regional perfusion for resuscitation of the kidneys before procurement and ex vivo lung perfusion after retrieval to assess lung functioning. All patients deceased on the emergency department (ED) between October 2014 and October 2015 within the age range of 18 – 50 were potential donors for kidneys and lungs, and in the age range of 51 – 65 potential lung donors. Donors could only be included when fulfilling all of the following inclusion criteria: a witnessed arrest, basic life support which started within 10 minutes, advanced life support within 20 minutes and resuscitation time within an organ-specific time span. Furthermore, the donors were excluded if there were any medical contraindications and permission for donation was not given. In total, 208 OHCA patients died on the ER from whom 32 were potential kidney donor and 68 lung donor. From the 32 potential kidney donors, 15 did not meet the inclusion criteria (47%), in 7 cases, there was no consent (22%), 9 showed medical contra-indications (28%), and once logistical problems occurred (3%). From the 68 potential lung donors, 22 did not meet the inclusion criteria (33%).18 did not consent (27%), 24 had medical contra-indications (35%) and 3 were cancelled due to logistical problems (5%). One donor satisfied all the criteria and was taken to the operating theatre for lung retrieval. However, during procurement the lungs were not suitable for transplantation. This pilot shows there is definitely a group of potential uDCD donors in the Netherlands. Nevertheless, due to a wide variety of reasons, up till now no uDCD donor resulted in organ retrieval. Although there were a wide variety of reasons why donation in this pilot was not successful, combining new techniques with new organ sources remains at least part of the solution for the organ shortage. We are obliged to explore these organ sources furthermore