Development and influence factors of China donation after cardiac death: single-center experience

Abstract

Objective To summarize the development of China donation after cardiac death (DCD), influence factors of DCD potential donors and application of extracorporeal membrane oxygenation (ECMO) in DCD. Methods The clinical data of DCD donors in Guangzhou General Hospital of Guangzhou Military of PLA Organ Procurement Organization (OPO) during January 2010 and December 2015 was analyzed retrospectively, mainly focusing on the indexes like the total number of DCD, average growth rate per annum, donation rate per million population (PMP), discard of DCD donor liver, proportion of C-Ⅰ, C-Ⅱ and C-Ⅲ, influence factors of organ donation in DCD potential donors and the ECMO application in DCD. The data of DCD of China and Guangdong province during the same period was also summerized. Chi-square test and Man-Whitney U test was used to compare the proportion of C-Ⅰ between our hospital and China and average growth rate per annum between our hospital and Guangdong province, respectively. P<0.5 was deemed statiatically significant. Results There were 241 DCD donors during January 2010 and December 2015 in our hospital, with C-Ⅰ, C-Ⅱ and C-Ⅲ accounting for 29.9% (72/241) , 26.6% (64/241) and 43.5% (105/241), respectively. The proportion of C-Ⅰ(29.9%) in our hospital was higher than national average (13%) (χ2=55.381, P 0.05). The donation rate per million population of our hospital and Guangdong province was increased from 0.407 PMP and 0.144 PMP to 3.948 PMP and 4.145 PMP, respectively. The donation conversion rate was 31.0% (241/778) within the scope of the OPO of our hospital. The influence factors for poor conversion rate were mainly because of family and social factors, the condition of donors and doctor-patient relationship. One hundred and forty-five DCD donors were implemented organ donation supported by ECMO during the same period, with C-Ⅰ, C-Ⅱ and C-Ⅲ accounting for 58.3% (42/72), 62.5% (40/64) and 60.0% (63/105). Conclusion Enhancing the attention and acceptance of organ donation in public, and reasonable application of organ preservation technology will help to promote the development of DCD liver transplantation. Key words: Donation after cardiac death; Influence factors; Conversion rate; Extracorporeal membrane oxygenation; Liver transplantation