Controlled Organ Donation After Cardiac Death: Potential Donors in the Emergency Department

Abstract

BACKGROUND.: The continuing shortfall of organs for transplantation has increased the use of donation after cardiac death (DCD). We hypothesized that some patients who undergo tracheal intubation in the emergency department (ED) and who are assessed for, but not admitted to, critical care might have potential for controlled DCD. METHODS.: We identified all patients who underwent tracheal intubation in the ED between 2004 and 2008 and studied their records to identify those not admitted to an intensive care unit. We reviewed the notes of patients extubated in the ED to ascertain the diagnosis, management, outcome, and potential exclusion criteria for controlled DCD. RESULTS.: One thousand three hundred seventy-four patients had tracheal intubation performed in the ED; 1053 received anesthetic drugs to assist intubation. Three hundred seventy-five patients were not admitted to intensive care unit; 235 died during resuscitation in the ED. Of the 49 patients extubated in the ED to allow terminal care, 26 were older than 70 years and 18 had comorbidities precluding organ donation. Fourteen patients could have been considered for DCD, but in eight, the time from extubation to death exceeded 2 hr. Thus, six patients might have been missed as potential controlled DCD from the ED in this 5-year period. CONCLUSIONS.: Identification of potential donors after cardiac death in the ED with appropriate use of critical care for selected patients may contribute to reducing the shortfall of organs for transplantation, although numbers are likely to be small. This area remains controversial and requires further informed discussion between emergency and critical care doctors and transplant teams.

Solid organ donation from the emergency department – A systematic review

“…There were six death reviews that screened for potential donation after circulatory determination of death donors, using pre-specified criteria; however, the criteria varied between studies. 11,25,[31][32][33][34] Three death reviews investigated potential controlled donation after circulatory determination of death donors hospital-wide and found that 2.3%-3.6% died in the ED. 11,31,32 Similarly, two death reviews investigated potential uncontrolled donation after circulatory determination of death donors hospital-wide and found that 67%-75% died in the ED.…”

Increasing Rates of Kidney Failure Care in Canada Strains Demand for Kidney Donors

“…-Younger than 70, in alignment with methods used in past Canadian 15 and international studies; 39,40 and -Younger than 80, to reflect evolving practice and growing acceptance of older donors. 6 Factors Associated With Conversion A hierarchical logistic regression (main fixed effects model without random effects) was used to determine factors associated with becoming an organ donor.…”

Donation After Cardiac Death and the Emergency Department: Ethical Issues

“…Over a 5-year period in an ED averaging 100,000 visits a year, they found only 49 patients who had terminal withdrawal of life support, only 14 of whom would have been eligible for DCD. 4 Several other locales have developed out-of-hospital arrest DCD protocols. A recent pilot project in New York City yielded no donors after a 6-month trial period.…”

“…Emergency physicians may be called upon to participate in a hospital's controlled DCD protocol with very ill patients in the ED 4 and thus need to be familiar with controlled DCD. However, the most likely scenario in which EPs would become involved in DCD is through uncontrolled DCD, either with patients who are brought in from the field under such a protocol or with patients who fail ED resuscitation.…”

“…Several European health care systems have implemented protocols to allow DCD in both of these settings, and some U.S. cities have piloted similar protocols. [4][5][6][7][8] Although emergency physicians (EPs) will likely have little involvement with inpatient DCD protocols and cases, these extended protocols directly involve EPs. Indeed, EPs will likely lead the way in implementing these protocols and even determining how widespread and accepted they are.…”