Impact of a national controlled donation after circulatory death (DCD) programme on organ donation: a 10 year study

Abstract

Background: Organ transplantation is the most successful treatment for some forms of organ failure yet a lack of organs mean many die on the waiting list. In the UK, the Organ Donation Taskforce was set up to identify barriers to organ donation and in 2008 released its first report (ODTR). This study assesses the success since the ODTR and examines the impact of the UK’s controlled Donation after Circulatory Death (DCD) programme and the controversies surrounding it. Methods: The NHSBT database and Potential Donor Audit database were interrogated for eligible donors from April 2004 to March 2014. Results: There were 12864 intended Donation after Brain Death (DBD) or DCD donors. When the 5 years preceding the ODTR was compared to the 5 years following, there was a 292% increase in intended DCD donors (1187 to 4656), but only an 11% increase in intended DBD donors (3327 to 3698). Organs retrieved per intended DBD donor remained static (3.30 to 3.26), whereas there was a decrease in DCD (1.54 to 0.99) due to a large rise in donors that didn’t proceed to donation (325 to 2464). The majority of DCD donors who proceeded died in the first 30 minutes from time of withdrawal. Conclusion: There was an unprecidented increase in activity following the ODTR, however the largest increase was in intended DCD donors of which now the majority do not progress. This study suggests further work on converting eligible referrals to organ donation and explororing methods of converting DCD to DBD donors may improve the situation further.