Premortem anticoagulation timing and dose in donation after circulatory death: multicentre study of associations with graft function

Abstract

Background:In controlled donation after circulatory determination of death (DCD), it is common to administer premortem heparin to potential donors. This practice remains controversial because there is limited evidence for it and there is the possibility of inducing hemorrhage. To our knowledge, no previous studies have assessed the effects of heparin timing and dose on graft function. Methods:We performed a multicentre cohort study of consecutive DCD donors and the recipients of their organs. Anti coagulation administration was considered early if given near the time of withdrawal of life-sustaining measures and late if delayed until the onset of donor hypoxemia (oxygen saturation < 70%) or hypotension (systolic blood pressure < 60 mm Hg or mean blood pressure < 50 mm Hg). The anticoagulation dose was considered high if it was 300 units/kg or greater.Results: Donor anticoagulation data were available for 301 kidney, 75 liver and 46 lung recipients. Heparin was administered in 92% of cases and was most commonly withheld in donors with cerebrovascular causes of death (p = 0.01). Administration was late in 59% and the dose was low in 27%. Among kidney recipients, there were no significant differences in need for dialysis, glomerular filtration rate over the first year after transplantation or graft survival on the basis of whether or not the donor received heparin, the timing of heparin administration or the dose of heparin. Among liver recipients, alkaline phosphatase concentrations over the first year were significantly higher among recipients who received organs from donors to whom lower doses of heparin had been administered.

Pre-Mortem Interventions for the Purpose of Organ Donation: Legal Approaches to Consent

“…Because PMIs offer no medical benefit and include at least the possibility of harm to the still-living patient, questions arise as to whether and, if so, when it is ethical 4 and legal to perform them. Perimortem research on organ donors 5 raises similar issues. 6 In most jurisdictions, the law requires consent to perform medical interventions on living patients with very few exceptions (e.g., an urgent need to proceed without consent to save a person's life).…”