Utilizing Rapid DCD Cases to Increase Number of Transplants

Abstract

Introduction Intermountain Donor Services (IDS) is an organ procurement organization serving a population of 3.6 million people in Utah, southeastern Idaho, western Wyoming, and a small portion of Nevada. In the United States, ethical guidelines indicate families should not be approached about organ donation after cardiac death (DCD) until after the decision to withdraw ventilator support. In 2012, IDS set a goal to facilitate DCD cases in situations of donor instability and requests by families to withdraw support immediately. IDS identified minimum requirements needed before completing a DCD recovery and worked with transplant centers, hospitals, and recovery personnel to implement a program to recover organs within two hours of consent. Methods IDS identified two hours from consent to withdrawal as the minimum time to complete needed tests and gather required information before organ recovery. Protocols were developed within IDS and between local recovery surgeons to ensure availability of a recovery surgeon despite this short time frame. Training was completed with donor hospitals and applicable personnel on how to offer this service when families want to withdraw support immediately. Additionally, IDS staff negotiated for as much time as possible to increase the opportunity for liver transplants, when applicable. Results During 2013-2016, twenty-five DCDs were completed within 0-3 hours of notification and organ recovery. Of these, 48 kidneys and five livers were transplanted. Thirty-one DCDs were attempted within 3-6 hours of notification and organ recovery. Of these, 44 kidneys and two livers were transplanted. This represents 47% of all DCD cases during this four-year period. The DCD rate for IDS as a percent of all donors was 24.2%. Although the time frame could be taxing to IDS staff and transplant recovery teams, the positive outcomes of those receiving transplants and fulfilling the wishes of the donors and their families outweighed any challenges. Conclusion IDS teams and recovery staff can respond within short time frames that were once considered impossible due to logistical issues. The opportunity for IDS staff to meet directly with donor families who want to withdraw immediately provides a window to negotiate longer time frames. Donor hospitals have seen the success of rapid DCD and have improved on providing timely referrals and a window for IDS staff to arrive before withdrawing support.