Assessing unrealised potential for organ donation after out-of-hospital cardiac arrest

• Published in: Scandinavian journal of trauma, resuscitation and emergency medicine Vol. 29; no. 1; pp. 105 - 8
• Main Authors: Ho, Andrew Fu Wah, Tan, Timothy Xin Zhong, Latiff, Ejaz, Shahidah, Nur, Ng, Yih Yng, Leong, Benjamin Sieu-Hon, Lim, Shir Lynn, Pek, Pin Pin, Gan, Han Nee, Mao, Desmond Renhao, Chia, Michael Yih Chong, Cheah, Si Oon, Tham, Lai Peng, Ong, Marcus Eng Hock
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28-07-2021; Springer Nature B.V; BioMed Central; BMC
• Subjects: Abdomen; Aged; Blood & organ donations; Cardiac arrest; Cardiopulmonary Resuscitation; Care and treatment; CPR; CPR (First aid); Death; Diabetes; Donation of organs, tissues, etc; Emergency medical care; Extracorporeal cardio-pulmonary resuscitation; Female; HIV; Hospitals; Human immunodeficiency virus; Humans; Hypertension; Infections; Kidney diseases; Male; Organ donation; Original Research; Out-of-Hospital Cardiac Arrest - therapy; Pan-Asian resuscitation outcomes study; Patient outcomes; Patients; Population; Retrospective Studies; Review boards; Statistics; Tissue and Organ Procurement; Tissue Donors; Transplant; Transplants & implants; Trauma; Uncontrolled donations after cardiac death; Singapore; Pan-Asian resuscitation outcomes study; Uncontrolled donations after cardiac death; Organ donation; Extracorporeal cardio-pulmonary resuscitation; Cardiac arrest; Transplant
• ISSN: 1757-7241; 1757-7241
• DOI: 10.1186/s13049-021-00924-z

Organ donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study.
Using Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered.
12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario, n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario, n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year).
In Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.