Intensive Care to Facilitate Organ Donation: A Report on the 4-Year Experience of a Spanish Center With a Multidisciplinary Model to Promote Referrals Out of the Intensive Care Unit

• Published in: Transplantation proceedings Vol. 51; no. 9; pp. 3018 - 3026
• Main Authors: Mazo, Cristopher, Gómez, Aroa, Sandiumenge, Alberto, Baena, Jacinto, Báguena, Marcelino, Nuvials, Francesc Xavier, Ferrer, Ricard, Boned, Sandra, Rubiera, Marta, Pont, Teresa
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2019
• Subjects: Adult; Critical Care - methods; Humans; Intensive Care Units; Male; Organ Transplantation - methods; Referral and Consultation; Retrospective Studies; Spain; Terminal Care - methods; Terminal Care - psychology; Tissue and Organ Procurement; Tissue Donors - supply & distribution; Spain
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2019.08.025

Intensive care to facilitate organ donation (ICOD) has been defined as the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom treatment for curative purposes is deemed futile, and who are considered possible organ donors, with the aim of offering donation after brain death (DBD) inside their end-of-life care plans. We describe the effect on the donation and transplantation activity of the implementation of ICOD protocol at a university hospital.
Retrospective analysis (2015-2018) of demographics and outcomes of all patients with a DBI, in whom ICOD was considered as part of their end-of-life care in Vall d’Hebron University Hospital, Barcelona.
Of the 983 possible donors evaluated, ICOD was considered in 206 (21%), of whom 115 (55.8%) were medically unsuitable for donation. Family consent was obtained for 69 (76%) of the remaining patients. Refusal rate was twice as high when nontherapeutic ventilation was required for organ donation (34%) vs patients previously ventilated (13.6%) (P = .02). Patients subject to ICOD died in a median of 2 days (1-3 d) and 88.4% became actual donors (39 after brain death; 22 after circulatory death). Nine (17.6%) donors were finally not utilized. ICOD contributed to 29% (ranging from 27.7% in 2015 to 31.6% in 2018) of the 208 actual donors and 26% of the 603 organs transplanted.
ICOD is well-accepted by families and offers the donation option to an increasing number of patients at our hospital. It provides an important and sustained increment of the organ pool for transplantation.
•New technologies can help detect and refer possible donors outside the intensive care unit (ICU).•Intensive care to facilitate organ donation (ICOD) is as well accepted by families as other standard scenarios in organ donation.•Nontherapeutic ventilation is the cornerstone in the consent for ICOD.•ICOD permits organ donation to increase by up to one third.•ICOD represents less than 1% of ICU admissions with a median stay of only 2 days.