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An Under-Recognized Benefit of Cardiopulmonary Resuscitation: Organ Transplantation*

Orioles, Alberto MD1; Morrison, Wynne E. MD, MBE1; Rossano, Joseph W. MD, MS2; Shore, Paul M. MD, MS3; Hasz, Richard D. BS, MFS, CPTC4; Martiner, Amy C. BA4; Berg, Robert A. MD1; Nadkarni, Vinay M. MD, MS1

doi: 10.1097/CCM.0b013e31829a7202
Review Articles

Objective: For many patients who suffer cardiac arrest, cardiopulmonary resuscitation does not result in long-term survival. For some of these patients, the evolution to donation of organs becomes an option. Organ transplantation after cardiopulmonary resuscitation is not reported as an outcome of cardiopulmonary resuscitation and is therefore overlooked. We sought to determine the number and proportion of organs transplanted from donors who received cardiopulmonary resuscitation after a cardiac arrest in the United States and to compare survival of organs from donors who had cardiopulmonary resuscitation (cardiopulmonary resuscitation organs) versus donors who did not have resuscitation (noncardiopulmonary resuscitation organs).

Data Source: We retrospectively analyzed a nationwide, population-based database of all organ donors and recipients from the United Network for Organ Sharing between July 1999 and June 2011.

Study Selection: We queried the database for all organs from deceased donors between July 1999 and June 2011. Organs from living donors (n = 76,015), all organs with missing cardiopulmonary resuscitation data (n = 59), and organs procured following a circulatory determination of death (n = 12,030) were excluded.

Data Extraction: We report donor demographic data and organ survival outcomes among organs from donors who received cardiopulmonary resuscitation (cardiopulmonary resuscitation organs) and donors who had not received cardiopulmonary resuscitation (noncardiopulmonary resuscitation organs). Graft survival of cardiopulmonary resuscitation organs versus noncardiopulmonary resuscitation organs was compared using Kaplan-Meier estimates and stratified log-rank test.

Data Synthesis: In the United States, among the 224,076 organs donated by donors who were declared dead by neurologic criteria between 1999 and 2011, at least 12,351 organs (5.5%) were recovered from donors who received cardiopulmonary resuscitation. Graft survival of cardiopulmonary resuscitation organs was not significantly different than that of noncardiopulmonary resuscitation organs.

Conclusions: At least 1,000 organs transplanted per year in the United States (> 5% of all organs transplanted from patients declared dead by neurologic criteria) are recovered from patients who received cardiopulmonary resuscitation. Organ recovery and successful transplantation is an unreported beneficial outcome of cardiopulmonary resuscitation.

1Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.

2Department of Pediatrics, Cardiac Center, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.

3Department of Pediatrics, Saint Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, PA.

4Gift of Life Donor Program, Philadelphia, PA.

* See also p. 2833.

Publication types: Nationwide, population-based, database review study.

Supported, in part, by 234-2005-37011C from Health Resources and Services Administration. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Drs. Hasz and Martiner are employed by the local Organ Procurement Organization (Gift of Life Donor Program, Philadelphia). Following design of the study and identification of the data source and elements, they did not have access to the data. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: a_orioles@hotmail.com

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins