Timing is Everything: Potential Missed Opportunities for Organ Donation after Circulatory Death due to Untimely Referral
CCCF ePoster library. Dhanani S. Nov 1, 2016; 150948; 68 Disclosure(s): Sonny Dhanani was Chief Medical Officer of Trillium Gift of Life Network. Clare Payne is Director of the Provincial Resource Centre for Trillium Gift of Life Network. Cynthia Isenor was previously employed with Trillium Gift of Life Network and is now the Health Services Manager for the Critical Care Organ Donation Program at the Nova Scotia Health Authority.
Dr. Sonny Dhanani
Dr. Sonny Dhanani
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Topic: Retrospective or Prospective Cohort Study

Timing is Everything: Potential Missed Opportunities for Organ Donation after Circulatory Death due to Untimely Referral


Kristina Krmpotic1; Clare Payne2; Cynthia Isenor3; Sonny Dhanani2,4
 

1Pediatric Critical Care Medicine, Janeway Children’s Health and Rehabilitation Centre, and Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada; 2Trillium Gift of Life Network, Toronto, Ontario, Canada; 3Nova Scotia Health Authority, Critical Care Organ Donation Program, Halifax, Nova Scotia, Canada; 4Pediatric Critical Care Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada



Abstract:

Introduction: Although rates of deceased donors for solid organ transplant have steadily increased in Canada over the past decade,1 the number of patients awaiting transplantation continues to remain much higher than the number of organs transplanted each year. Donation after circulatory death (DCD) allows for the procurement of organs after planned withdrawal of life-sustaining therapy (WLST) and subsequent cardiorespiratory arrest, and increases the potential for successful donations. It has accounted for a larger proportion of deceased donors in Canada each year since the publication of national guidelines in 2006,2,3 but the steady increase in the number of patients listed for transplant each year is far greater than current organ donation practices can sustain and the gap between organ supply and demand continues to widen.

Objective: To determine the potential to increase deceased donation rates further by identifying gaps in the established DCD process in the province of Ontario.

Methods: Using the administrative database maintained by Trillium Gift of Life Network, we conducted a retrospective cohort study of 1407 hospital deaths following planned withdrawal of life-sustaining therapy (WLST) in Ontario, Canada between April 1, 2013 and March 31, 2015. We examined rates of medical suitability, referral, approach, consent, and donation, time from WLST to first declaration of death, and number of organs transplanted.

Results: Of the 1407 patients identified, 48.9% died within 2 hours of planned WLST and were deemed medically suitable for DCD. Nearly half (44.2%) of these potential donors did not have next of kin approached regarding organ donation, most often because referral was made at the time of or after planned WLST in both academic, tertiary care referral centres (20.1%) and community hospitals (18.5%). Consent rates for approached cases were 39.9%, with an overall donation conversion rate of 17.0%.

Conclusion: Almost half of the patients in our study were eligible for DCD, based on time from WLST to first declaration of death, and medical suitability as determined by TGLN. However, over one-third of these were missed potential cases since they were not referred until the immediate time of WLST or after WLST had already occurred. The number of potential organ donors identified is nearly 6 times higher than the number of actual organ donors by DCD, with the greatest loss of potential due to untimely referral. Assuming similar rates of consent and organ procurement in this population, earlier referral could potentially yield a 1.6 fold increase in actualized donation rates and potentially save an additional 120 lives.


References:

1. Hernandez-Alejandro R, Wall W, Jevnikar A, et al. Organ donation after cardiac death: donor and recipient outcomes after the first three years of the Ontario experience. Can J Anesth 2011; 58(7): 599-605.

2. Shemie SD, Baker AJ, Knoll G, et al. Donation after cardiocirculatory death in Canada. CMAJ 2006 175(8): S1-24.

3. Trillium Gift of Life Network. 2015 Statistics. https://www.giftoflife.on.ca/en/publicreporting.htm. Accessed December 9, 2015. Trillium Gift of Life Network. 2015 Statistics. https://www.giftoflife.on.ca/en/publicreporting.htm. Accessed August 2, 2016.



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