Is the Increase in DCD Organ Donors in the United Kingdom Contributing to a Decline in DBD Donors?

Summers, Dominic M.; Counter, Claire; Rj, Johnson; Murphy, Paul; Neuberger, James; Bradley, J. Andrew

doi:10.1097/tp.0b013e3182007b33

Cited by 39 publications

(36 citation statements)

References 15 publications

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“…Increased transplantation rates attributable to donation after cardiocirculatory death have been observed in other countries. 15,37 Outcomes using organs recovered after cardiocirculatory death have been favourable in Canada. However, the number of organs that can be transplanted is Excluded n = 146 • Neurologic death diagnosed using standard criteria † n = 25 • GCS score > 3 at the time of withdrawal of life-support n = 77 • GCS score 3 but at least 1 reactive pupil n = 44…”

Section: Main Findingsmentioning

confidence: 99%

“…Although neurologic death appears to have decreased in some other countries, investigators have been unable to determine specific reasons. 14,15,37,41 The Canadian Institute for Health Information regularly collects data regarding the number of "potential donors" who meet the criteria for neurologic death that have been referred to provincial organ donation agencies. 32,33 Definitions and reporting practices vary considerably across provinces, limiting the reliability and comparability of these data.…”

Section: Main Findingsmentioning

confidence: 99%

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Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Kramer

Zygun

Doig

et al. 2013

CMAJ

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Section: Main Findingsmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Kramer

Zygun

Doig

et al. 2013

CMAJ

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“…Analysis of data does not attribute this fall in DBD donors to the expansion in DCD donation in the UK [30], but it is an important consideration, as there are advantages to DBD donation in terms of both number of organs donated and organ quality [16].…”

Section: Expanding the Donor Pool Through Dcdmentioning

confidence: 99%

Kidney donation after circulatory death: current evidence and opportunities for pediatric recipients

2015

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Organ donation after circulatory death (DCD) has experienced a revival worldwide over the past 20 years, and is now widely practiced for kidney transplantation. Some previous concerns about these organs such as the high incidence of delayed graft function have been alleviated through evidence from adult studies. There are now a number of large adult cohorts reporting favorable 5-year outcomes for DCD kidney transplants, comparable to kidneys donated after brain death (DBD). This has resulted in a marked increase in the use of DCD kidneys for adult recipients in some countries and an increase in the overall number of kidney transplants. In contrast, the uptake of DCD kidneys for pediatric recipients is still low and concerns still exist over the longer-term outcomes of DCD organs. In view of the data from adult practice and the poor outcomes for children who stay on dialysis, DCD kidney transplantation should be offered as an option for children on the kidney transplant waiting list.

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“…The second is whether there is, or has been, a "cost" to our donor rates through uncritical acceptance both of this hypothesis and the idea that Australia is somehow "different" to other western democracies in terms of improvements made to public health and safety. While Australia's achievements in improving levels of public health and safety are laudable, and, as some evidence in both Spain and the UK demonstrates, might have shrunk the potential donor pool by reducing the over-all number of Australians who would potentially become brain dead (4,21,22), very recent evidence from Spain shows that this shrinkage in the potential donor pool can be more than compensated for through implementation of hospital-wide donor best practice recommendations and through the development of a systemic approaches to organ donation that include, but are not limited to the identification and management of donors in hospitals (23). The fact that many leading donor countries have been successful at improving deceased donation rates while at the same time achieving impressive improvements in public health and safety, suggests that improvements in public health and safety are not a sufficient explanation for Australia's low organ donor rates.…”

Section: Discussionmentioning

confidence: 99%

Explaining failure through success: a critical analysis of reduction in road and stroke deaths as an explanation for Australia's low deceased organ donation rates

Bendorf

Kerridge

Kelly

et al. 2012

Internal Medicine Journal

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Background/Aim: During the past two decades, Australian federal and state governments have funded many initiatives to bolster organ donation. Despite large investments of time, effort and money, Australia's deceased donation rate is in the bottom half of the Organisation for Economic Co‐operation and Development countries and has only marginally increased from 11.9 donors per million people (pmp) in 1990 to 14.9 donors pmp in 2011. An often‐cited explanation for this situation is that Australia's success in increasing levels of public health and safety through reduced traffic and stroke fatalities has reduced its number of potential deceased organ donors. We refer to this as the ‘Failure Because of Success’ hypothesis. Although commonly accepted, this hypothesis is largely untested. Methods: By analysing data from international donation and transplantation organisations and international public health and safety organisations, we compared historical deceased organ donation rates with traffic and stroke fatality rates in Australia and the seven countries with the world's highest deceased organ donation rates (Spain, Portugal, France, USA, Belgium, Austria and Italy). Results: Traffic fatality rates across all countries in the study have fallen dramatically during the time period, with Spain having the lowest traffic fatality rates. Stroke fatality rates demonstrate similar reductions, with France showing the lowest cerebral vascular accident mortality rates. Conclusion: When compared with countries with the world's highest deceased donation rates, Australia's improvements to public health and safety through reductions in traffic and stroke fatalities were neither unique nor exemplary and do not provide an adequate explanation for its low organ donor rates.

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Is the Increase in DCD Organ Donors in the United Kingdom Contributing to a Decline in DBD Donors?

Abstract: There is no evidence that the increase in DCD donors has contributed directly to the decline in DBD, which reflects a decrease in the number of patients with brain death.

Cited by 39 publications

References 15 publications

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Kidney donation after circulatory death: current evidence and opportunities for pediatric recipients

Explaining failure through success: a critical analysis of reduction in road and stroke deaths as an explanation for Australia's low deceased organ donation rates

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