Organ donation after traumatic cardiopulmonary arrest

The gap between demand of transplantable organs and their supply continues to widen. Trauma patients constitute a significant proportion of organ donors. The incidence of organ donation after traumatic cardiopulmonary arrest (TCPA), however, is not clear. The goals of this study were to determine the success rate of organ donation in patients undergoing cardiopulmonary resuscitation (CPR) after trauma and to determine if there are variables that may predict successful organ donation.

All trauma patients who sustained TCPA from April 2007 to March 2010 were reviewed. We identified all patients who required CPR in the field or the trauma center. Patients were classified as donors if the heart, lung, kidney, small bowel, pancreas, or liver was harvested. Primary outcome was organ donation after CPR.

A total of 252 patients required CPR for TCPA in the field or in the trauma center. There were 39 (15.5%) survivors and 213 (84.5%) fatalities. Only 19 of 213 (8.9%) patients who died after TCPA became organ donors. A total of 26 organs were harvested including 15 kidneys, 6 livers, 4 hearts, and 1 pancreas. Of those who failed to donate organs, 64.7% had a cardiac arrest after the donor network had been contacted but before their arrival.

Survival rate after TCPA is low but organ donation is an important secondary outcome. Patients with predominant head injuries, without thoracic and minimal extremity injuries, should be identified as having a higher chance of going on to organ donation. The greatest barrier to organ donation in TCPA patients is cardiac arrest before donor network arrival.