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Factors That Complicated the Implementation of a Program of Donation After Unexpected Circulatory Death of Lungs and Kidneys. Lessons Learned From a Regional Trial in the Netherlands

Venema, Leonie H. MSc1; Brat, Aukje MD1; Nijkamp, Danielle M.1; Krikke, Christina MD1; Leuvenink, Henri G.D. PhD1; de Jongh, Wim C.2; Tromp, Tjarda N.3; Van der Vliet, J. Adam MD, PhD3; Bens, Bas W.J. MD4; Erasmus, Michiel E. MD, PhD5

doi: 10.1097/TP.0000000000002814
Original Clinical Science—General
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Background. Organ shortage remains a problem in transplantation. An expansion of the donor pool could be the introduction of unexpected donation after circulatory death (uDCD) donors. The goal of this study was to increase the number of transplantable kidneys and lungs by implementing a uDCD protocol.

Methods. A comprehensive protocol for uDCD donation was developed and implemented in the emergency departments (EDs) of 3 transplant centers. All out-of-hospital cardiac arrest (OHCA) patients were screened for uDCD donation. Inclusion criteria were declaration of death in the ED, age (<50 y for kidneys, <65 y for lungs), witnessed arrest, and basic and advanced life support started within 10 and 20 min, respectively.

Results. A total of 553 OHCA patients were reported during the project, of which 248 patients survived (44.8%). A total of 87 potential lung and 42 potential kidneys donors were identified. A broad spectrum of reasons resulted in termination of all uDCD procedures. Inclusion and organ-specific exclusion criteria were the most common reason for not proceeding followed by consent. None of the potential donors could be converted into an actual donor.

Conclusion. Although uDCD potential was shown by successful recognition of potential donors in the ED, we were not able to transplant any organs during the study period. The Dutch Emergency medical service guidelines to stop futile OHCA in the prehospital setting and the strict use of inclusion and exclusion criteria like age and witnessed arrest hampered the utilization. A prehospital uDCD protocol to bring all OHCA patients who are potential uDCD candidates to an ED would be helpful in creating a successful uDCD program.

1 Department of Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.

2 Department of Surgery, Maastricht University Medical Center, University of Maastricht, The Netherlands.

3 Department of Surgery, Radboud University Medical Center, Radboud University, The Netherlands.

4 Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, The Netherlands.

5 Department of Thoracic Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.

Received 6 March 2019. Revision received 29 April 2019.

Accepted 15 May 2019.

L.H.V. was the overall project manager, provided the logistics during the project, participated in data collection and analysis, and wrote the article. A.B. was the designated transplant coordinator, provided the logistics during the project, participated in data analysis, and wrote the article. D.N. was the project manager and designed and wrote the protocol that was used in all centres. C.K. was the designated abdominal surgeon on the project and program supervisor. H.G.D.L. was the researcher and played a supervising role in writing the article. W.C.d.J. was the project leader in Maastricht University Medical Center, provided logistics during the project, participated in data collection, and a transplant coordinator. T.N.N. prepared logistics during the project and participated in data collection. J.A.v.d.V. was the designated abdominal surgeon on the project and project leader in Radboud University Medical Centre. B.W.J.B. was the designated emergency medical physician, designed and wrote the protocol that was used in all centers, and provided logistics and training on the emergency departments. M.E.E. was the designated thoracic surgeon on the project and program supervisor.

L.H.V. and A.B. contributed equally.

B.W.J.B. and M.E.E. contributed equally.

The authors declare no conflicts of interest.

The implementation of the unexpected donation after circulatory death (uDCD) protocol within this study is financed by the Dutch ministry of public health.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Leonie H. Venema, MSc, Department of Surgery, University of Groningen, University Medical Center Groningen, CMC V Y2144, BA44, Hanzeplein 1, 9713 GZ Groningen. (l.h.venema@umcg.nl).

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