Association between cause of death and organ yield in organ donation after circulatory death in Canada
CCCF ePoster library. DAragon F. 11/11/19; 285169; EP43 Disclosure(s)(s): Nothing to disclose
Frederick DAragon
Frederick DAragon
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

D'Aragon Frederick1,2, Burns E.A. Karen3,4, Chasse Michael5, Frenette Anne-Julie6,7, Ball Ian8,9, Rochwerg Bram10, English Shane11, Boyd Gordon12,13, Kramer Andreas14, Healey Andrew10, Dhanani Sonny15, Lauzier Francois16,17, Keenan Sean18,19,Wang Han Ting5, Isac George20, Wood Gordon21, Breau Ruth22, Hand Lori22, Masse Marie-Helene2, Ibrahim Quazi22, Lamontagne Francois2,23, Meade Maureen10,22 on behalf of the Canadian Critical Care Trials Group and Canadian Donation and Transplantation Research Program
 
1Department of Anesthesiology, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
2Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
3Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
4Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
5Department of Medicine (Critical Care), Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
6Pharmacy faculty, Universite de Montreal, Montreal, Quebec, Canada
7Hopital Sacre-Coeur de Montreal, Montreal, Quebec, Canada
8Department of Medicine, Western University, London, Ontario, Canada
9Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
10Department of Medicine, McMaster University, Hamilton, Ontario, Canada
11Department of Medicine (Critical Care), University of Ottawa, Ontario, Canada
12Department of Medicine (Neurology), Queen's University, Kingston, Ontario, Canada
13Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
14Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
15Division of Critical Care, Department of Pediatrics  Children's Hospital of Eastern Ontario University of Ottawa, Ottawa, Canada
16Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec city, Quebec, Canada
17Departments of Medicine, Université Laval, Quebec city, Quebec, Canada
18Department of Critical Care, University of British Columbia, British Columbia, Canada
19BC Transplant, British Columbia, Canada
20Department of Anesthesia, University of British Columbia, British Columbia, Canada
21Adult Intensive Care, Island HealthAuthority, Royal Jubilee Hospital, British Columbia, Canada
22Department of Health Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
23Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
 


Introduction: Anoxic brain injury is the most common diagnosis leading to organ donation after neurologic determination of death (NDD) in Canada. Frequency and associations between causes of death and organ yield are unclear among donation after circulatory death (DCD) donors.  .
Objective: To describe the distribution of causes of death in DCD donors and  the association between etiology of death and organ recovery.
Methods: Thirty-two Canadian hospitals participated in the prospective observational Canada-DONATE cohort study, enrolling 622 consecutive deceased adult organ donors (NDD and DCD) from 2015 to 2018. Data was collected prospectively, recording including: donor characteristics; medical history; primary cause of death; donor management interventions; organ donation specific therapies and death determination procedures, from one day prior to donation consent up to the time of organ recovery or the time that all organs are declined. We limited this analysis to DCD donors only. We defined patient descriptors (independent variables) by the primary cause of death, For this exploratory analysis, we determined the mean number of organs recovered for donation from those donors who were ultimately able to donate organs (dependent variable) and assessed the relationships between cause of death and other patient descriptors to the number of organ recovered using Chi-square analyses, the Student-T test or the Kruskal-Wallis test, as appropriate.
Results: Of 215 DCD donors, 155 (72.1%) had organs allocated prior to withdrawal of life sustaining therapies and 110 (51.2%) had at least one organ recovered. Mean DCD donor age was 53.6 ±14.1 and 37.2% were female. Sixty-five (30.2%) had anoxic brain injury, 56 (26.0%) traumatic brain injury, 53 (24.7%) brain hemorrhage, 19 (8.8%) ischemic stroke, and 22 (10.2%) had other diagnoses leading to organ donation (e.g; meningitis, cancer)(Table 1). Donor interventions were comparable between groups (Table 2). The average number of organs recovered per enrolled donor was 3.5 ± 1.6 with ischemic stroke, 3.1 ± 1.3 with TBI, 2.6 ± 1.1 with brain hemorrhage, 2.5 ± 1.0 with anoxic brain injury, and 2.4 ± 0.7 for other diagnoses (p = 0.05) (Table 3).
Conclusion: Anoxic brain injury is the most prevalent diagnosis leading to circulatory determination of death among deceased donors. In contrast to NDD, among DCD donors there is no apparent association between cause of death and organ recovery for transplantation. One potential explanation for these findings may be the potential impact of clinical judgment in the identification and selection of potential DCD donors.
 


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