Jennifer Axelband, DO, FACOEP,FCCM
St. Luke's Hospital
Bethlehem, Pennsylvania
Disclosure information not submitted.
Richard Hasz, BS, MSFS
Vice President of Clinical Services
Gift of Life Donor Program, United States
Disclosure information not submitted.
Sharon West, MS
Director of Donation and Transplantation Analytics
Gift of Life Donor Program, United States
Disclosure information not submitted.
Title: Uncontrolled DCD: Dose the method of chest compressions impact kidney transplant?
Introduction: The number of patients awaiting organ transplant continues to rise every year. Critical care and emergency medicine providers are at the frontline of identifying and managing potential organ donors and play a significant role in preserving organ perfusion for potential donation. Data on resuscitative interventions for patients in an unexpected cardiac arrest event who do not regain return of spontaneous circulation and the impact on organ recovery and donation are limited. Manual chest compression (CC) verses mechanical chest compression devices (MCCD) in an uncontrolled donation after circulatory death (UDCD) may have an impact on organ recovery and utilization.
Methods: A retrospective analysis of data from UDCD organ donors collected by our regional organ procurement organization, which includes 29 hospitals, from 2016 to 2021 evaluating patient demographics and impact of CPR method on kidney transplant.
Results: A total of 69 patients with a mean age of 32 years were identified as UCDC organ donors. The majority of donors were male (76.8%) and the most common causes of death were anoxia (49%) and head trauma (47.8%). MCCD resuscitation occurred in 22 (31.8%) donors compared to CC in 47 (68%) donors and non-transplant hospitals were more likely to use MCCD compared to transplant centers. For kidneys recovered, median warm ischemic time (WIT) was 116 minutes compared to 47 minutes respectively for MCCD vs CC. Both groups had similar number of kidneys pumped, mean pump time, final flow and resistance parameters (all p > 0.05). The utilization rate for kidneys recovered from MCCD resuscitation was 48% compared to74% for donors resuscitated with CC (p = 0.002). Delayed graft function was similar for both groups and primary non-function occurred in 6% of the CC group compared to 0% in the MCCD group (p >0.05).
Conclusion: Patients resuscitated with MCCD that transition to UCDC have longer WIT which may impact kidney utilization for transplant. Future studies evaluating pre-donation resuscitation are warranted to guide transplant medicine for organ utilization and best recipient outcome.