Patterns of organ donation among resuscitated patients at a regional cardiac arrest center

Abstract

Introduction: As organ demand outpaces supply in the United States, donation after cardiac death (DCD) is increasing, and the leading cause of death among donors is now cardiovascular/cerebrovascular disease. Selected patients resuscitated from cardiac arrest may be an under-recognized donor pool. Regional cardiac arrest centers are expected to address organ donation, but there are few guidelines available and the yield from this population is not fully known.

Methods: We characterized the progression of resuscitated cardiac arrest patients at a regional cardiac arrest center and transplant center from organ procurement organization (OPO) referral through procurement. We determined characteristics associated with donation, assessed temporal trends in referral and donation, and calculated the yield of organs from this cohort.

Results: Of 991 patients admitted between 2005 and 2011, 560 did not survive to hospital discharge. Of these, 530 (94.6%) were referred to the OPO and 75 (13.4%) had organs procured. Family refusal of otherwise suitable candidates precluded 71 procurements. Age, sex, arrest location, designated donor status, and family consent were associated with donation. The absolute number of admissions, referrals, and donors increased over the study period. The probability of OPO referral did not change, but the probability of donation increased. The overall yield was 1.8 solid organs and 1.3 eyes per donor, with the majority being transplanted.

Conclusions: Post-cardiac arrest patients represent a potential donor pool to help fill the widening gap between organ supply and demand in the United States. Formal multi-modal neurologic assessment may expedite referral to an organ procurement organization. These components should be considered as cardiac arrest center designation criteria.

Keywords: Cardiac arrest; Organ donation; Organ procurement; Organ supply; Resuscitation.