An International Analysis of Policy Shifts to Donation After Cardio-circulatory Death (DCD) and Their Effect on Deceased Organ Donation and Transplantation Rates

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Introduction: During the past decade an increasing number of countries have adopted policies that emphasize donation after cardio-circulatory death (DCD) in an effort to address the widening gap between demand and supply of transplantable organs. An analysis of international donation activity between 1989-2010 identified 25 countries that reported regular DCD activity. This research reports the impact of policy shifts towards increasing DCD upon overall deceased organ donation rates (DD), donation after brain death rates (DBD) and organ transplantation rates. Methods: Donor and transplant data was collected from multiple international donation and transplantation agencies and supplemented and cross-checked against responses to questionnaires sent to relevant national organ donor and transplant related bodies. Data was analyzed to determine correlations and associations between; DCD (both uncontrolled - Maastricht Class 1 & 2 (uDCD) and controlled Maastricht Class 3 & 4 (cDCD)); DBD; overall DD; and organ transplantation rates, with p = 0.05 considered significant. Results: Our results show that high national DD rates (> 20 DD pmp per year) were strongly associated with high DBD rates. In contrast, high DCD rates negatively impacted on a country's overall DD rate. In addition, there was a significant negative correlation (p = 0.0002) between DCD and DBD rates in countries with policies that resulted in high DCD rates. Finally, international data demonstrates that the total number of organs transplanted per donor is reduced by a factor of 1.5 in DCD when compared to DBD (p < 0.0001).Figure: [DCD Effect on DBD Rates]Figure: [Transplanted Organs per DCD & DBD Donor]Conclusion: While policies focused on uDCD may increase overall DD rates, increases in DD from policies that focus on cDCD come at the expense of DBD. We conclude that cDCD negatively impacts the number of donations from brain dead donors and may lead to an overall reduction in the number of transplants performed due to reduced organ retrieval rates.