Recent experience with organ donation after cardiac death (CDC) in one region of Australia

Introduction: Prior to 2004 there were 1-2 DCD donors per annum in our region. Renewed stakeholder and community interest in 2004 stimulated jurisdictional policy development and implementation - www.health.nsw.gov.au/ policies/gl/2007/GL2007_012.html. Here we describe our resulting recent experience with DCD organ donation. Methods: LifeGift records of all intended/actual DCD donors 1/2004-12/2008 were reviewed. An intended DCD donor is where death is not declared <60 minutes post treatment withdrawal precluding organ donation. Statistics were by SISA. Results: There were 13 intended and 33 actual DCD donors. All but one donor were Maastricht category 3. The number of actual DCD donors versus donors declared brain dead per annum significantly increased from 2/63 (3%) in 2004 to 10/57 (17%) in 2008 [p=0.008]. Underlying cause of death for actual DCD donors was CVA 15, hypoxia 7, trauma 6, ICH 4, multiple organ failure [on ECMO] 1. Median actual donor age was 44 (9-74) years. Treatment withdrawal was in intensive care in 82% and operating room in 18%. Median time from treatment withdrawal to declaration of death was 16 (5-31) minutes. Median donor warm ischaemic time was 31 (6-62) minutes. A total of 71 organs were retrieved and transplanted (organ utilization rate 2.15) - 62 kidneys, 3 livers and 6 sets of lungs. Organs discarded included 2 kidneys (trauma, +ve virology), and 1 liver [non perfusion]. Multiorgan DCD donation increased from 0% in 2004 to 17% in 2008 [p=NS]. Tissue procured from DCD donors included 16 sets of corneas and 17 heart valves. For the intended DCD donors the mean time to declaration of death post treatment withdrawal was 350 (55-1480) minutes. Conclusions: DCD organ donation has increased over the last 5 years predominantly form Maastricht category 3 donors. Organ discard rates are low for actual DCD donors. Multiorgan donation is now increasingly common.