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Is donation after cardiac death reducing the brain-dead donor pool in Australia?
Brett G Sampson1, Gerry P O'Callaghan, Graeme R Russ
1Flinders Medical Centre, Adelaide, SA, Australia. Brett.Sampson@health.sa.gov.au
Insights
Donation after cardiac death (DCD) has not reduced the brain-dead donor pool in Australia. Brain-injured donors are ventilated long enough for brain death to occur before DCD conversion.
Area of Science:
- Organ transplantation research
- Intensive care medicine
- Public health policy
Background:
- Donation after cardiac death (DCD) is increasing faster than donation after brain death (DBD) in Australia.
- DBD is preferred due to higher organ yield, simpler process, and optimized transplant outcomes.
- The study investigates the impact of rising DCD rates on the DBD donor pool.
Purpose of the Study:
- To determine if the increase in DCD has reduced the brain-dead donor pool in Australia.
- To analyze trends in ventilation periods for DBD and DCD donors.
- To assess the potential conversion of DBD donors to DCD pathways.
Main Methods:
- Retrospective analysis of organ donor records (intended and actual) in Australian intensive care units from 2001 to 2011.
- Focus on donors with brain injury as the cause of death.
- Examined changes in median ventilation duration before brain-death determination in DBD donors.
Main Results:
- The median ventilation period for DBD donors did not decrease as DCD increased (P = 0.83).
- The proportion of DBD and DCD donors ventilated for less than 2 days remained unchanged.
- DCD donors had significantly longer ventilation periods (3.8 days) compared to DBD donors (1.3 days; P < 0.0001).
Conclusions:
- Brain-injured donors in Australia are ventilated sufficiently to allow progression to brain death.
- The rise in DCD is unlikely to have diminished the availability of DBD donors.
- Current practices support adequate time for brain death determination before considering DCD.
Background:
Donation after cardiac death (DCD) has increased faster than donation after brain death (DBD) in Australia. However, DBD is the preferred pathway because it provides more organs per donor, the donation process is simpler and transplant outcomes are optimised.
Objective:
To determine if the increase in DCD has reduced the brain-dead donor pool in Australia.
Design, Setting And Participants:
Retrospective analysis of records of organ donors (intended and actual) with brain injury as the cause of death from 2001 to 2011 in Australian intensive care units.
Main Outcome Measures:
Change in median ventilation period, over time, before brain-death determination in DBD donors (as DCD increased); a decreased median ventilation period in DBD donors being consistent with the conversion of DBD to DCD.
Results:
As DCD (n = 311) increased, the median ventilation period in DBD donors (n = 2218) did not fall overall (P = 0.83), in all jurisdictions (P > 0.25) and for all causes of death (P > 0.3). The proportion of patients ventilated for less than 2 days was unchanged over time in both DBD (P = 1) and DCD (P = 0.99). The overall ventilation period in DCD donors (3.8 days; interquartile range [IQR], 2.1-6.3 days), exceeded the ventilation period in DBD donors (1.3 days; IQR, 1.0-2.4 days; P < 0.0001). DCD ventilation period was significantly longer in all jurisdictions, for all causes of death and annually (P < 0.05).
Conclusions:
In Australia, brain-injured donors appear to be ventilated long enough to allow progression to brain death before proceeding to DCD. Therefore, DCD is unlikely to have reduced the brain-dead donor pool.
