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Intensive Care to Facilitate Organ Donation

A Report on the Experience of 2 Spanish Centers With a Common Protocol

Martínez-Soba, Fernando, MD1; Pérez-Villares, José M., MD, PhD2; Martínez-Camarero, Lidia, MD1; Lara, Ramón, MD2; Monzón, José L., MD, PhD3; Fernández-Carmona, Alberto, MD2; Marco, Pedro, MD4; Coll, Elisabeth, MD, PhD5; Domínguez-Gil, Beatriz, MD, PhD5

doi: 10.1097/TP.0000000000002294
Original Clinical Science—General
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Background. The aim of this study is to report the experience with a program of Intensive Care to facilitate Organ Donation (ICOD) in 2 Spanish centers based on a common protocol.

Methods. Retrospective review of clinical charts of patients with a devastating brain injury whose families were approached to discuss the possibility of ICOD once further treatment was deemed futile by the treating team. Study period is from January 1, 2011, to December 31, 2015.

Results. ICOD was discussed with families of 131 patients. Mean age of possible donors was 75 years (SD = 11 years). The main cause of brain injury was an intracranial hemorrhage (72%). Interviews with families were held after the decision had been made not to intubate/ventilate in 50% of cases, and after the decision not to continue with invasive ventilation in the remaining cases. Most interviews (66%) took place in the emergency department. The majority of families (95%) consented to ICOD. Of the 125 consented cases, 101 (81%) developed brain death (BD), most in 72 hours or less. Ninety-nine (98%) patients transitioned to actual donation after BD, with 1.2 organs transplanted per donor. Of patients who did not evolve to BD, 4 died after an unexpected cardiac arrest and 18 after the withdrawal of life-sustaining measures. ICOD contributed to 33% of actual donors registered at both centers.

Conclusions. ICOD is well accepted by families. Most patients evolve to BD within a short period of time. The practice substantially contributes to increasing organ donation and offers more patients the chance of donating their organs after death.

1Donor Coordination Unit, Hospital de San Pedro, Logroño, Spain.

2Intensive Care Unit, Donor Coordination Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.

3Intensive Care Unit, Hospital San Pedro, Logroño, Spain.

4Emergency Department, Hospital San Pedro, Logroño, Spain.

5Organización Nacional de Trasplantes, Madrid, Spain.

Received 15 March 2018. Revision received 26 April 2018.

Accepted 14 May 2018.

The authors declare no funding or conflict of interests.

F.M.S., J.M.P.V., and B.D.G. conceived and designed the study. F.M.S., L.M.C., and J.M.P.V. contributed with the data required for the study. E.C. and B.D.G. coordinated the data collection and undertook the statistical analysis. J.L.M., A.F.C., and P.M. participated in the performance of the research. F.M.S., J.M.P.V. and B.D.G. drafted the first version of the article, with contributions from the rest of the authors.

Correspondence: Beatriz Domínguez-Gil, MD, PhD, Organización Nacional de Trasplantes. C/ Sinesio Delgado 6, Pabellón 3, 28029 Madrid, Spain. (bdominguez@msssi.es).

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