Estimating the potential pool of uncontrolled DCD donors in the United States

Brian J. Boyarsky, Kyle R. Jackson, Amber B. Kernodle, Joseph V. Sakran, Jacqueline M. Garonzik-Wang, Dorry L. Segev, Shane E. Ottmann

Research output: Contribution to journalArticle

Abstract

Organs from uncontrolled DCD donors (uDCDs) have expanded donation in Europe since the 1980s, but are seldom used in the United States. Cited barriers include lack of knowledge about the potential donor pool, lack of robust outcomes data, lack of standard donor eligibility criteria and preservation methods, and logistical and ethical challenges. To determine whether it would be appropriate to invest in addressing these barriers and building this practice, we sought to enumerate the potential pool of uDCD donors. Using data from the Nationwide Emergency Department Sample, the largest all-payer emergency department (ED) database, between 2013 and 2016, we identified patients who had refractory cardiac arrest in the ED. We excluded patients with contraindications to both deceased donation (including infection, malignancy, cardiopulmonary disease) and uDCD (including hemorrhage, major polytrauma, burns, and poisoning). We identified 9828 (range: 9454-10 202) potential uDCDs/y; average age was 32 years, and all were free of major comorbidity. Of these, 91.1% had traumatic deaths, with major causes including nonhead blunt injuries (43.2%) and head injuries (40.1%). In the current era, uDCD donors represent a significant potential source of unused organs. Efforts to address barriers to uDCD in the United States should be encouraged.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • clinical research/ practice
  • donors and donation: deceased
  • donors and donation: donation after circulatory death (DCD)
  • ethics and public policy
  • kidney transplantation/nephrology
  • law/legislation
  • organ allocation
  • organ procurement
  • organ procurement and allocation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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  • Cite this

    Boyarsky, B. J., Jackson, K. R., Kernodle, A. B., Sakran, J. V., Garonzik-Wang, J. M., Segev, D. L., & Ottmann, S. E. (Accepted/In press). Estimating the potential pool of uncontrolled DCD donors in the United States. American Journal of Transplantation. https://doi.org/10.1111/ajt.15981