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Published on: June 6, 2025
Changing Patterns of Organ Donation: Brain Dead Donors Are Not Being Lost by Donation After Circulatory Death
Helen M Nelson1, Alexandra K Glazier, Francis L Delmonico
11 New England Organ Bank, Boston, MA.
Insights
The New England Organ Bank (NEOB) found that over 30% of deceased donors were donors after circulatory death (DCD). Transitioning DCD donors to brain death donors (DBD) successfully yielded 276 transplanted organs, expanding deceased donation.
Area of Science:
- Organ transplantation
- Medical research
- Public health
Background:
- Donors after circulatory death (DCD) represent a significant portion of deceased organ donors.
- Effective coordination of DCD donors is crucial for maximizing organ availability.
- The New England Organ Bank (NEOB) has experience in managing DCD donors.
Purpose of the Study:
- To analyze the clinical characteristics of DCD donors at NEOB.
- To evaluate the outcomes of DCD donor conversions to brain death donors (DBD).
- To provide a reference for successful DCD implementation and expansion of deceased donation.
Main Methods:
- Retrospective analysis of DCD donors coordinated by NEOB from July 1, 2009, to June 30, 2014.
- Evaluation of potential DCD donors, actual DCD donors, and those transitioning to DBD.
- Tracking of organ transplantation numbers from transitioned donors.
Main Results:
- NEOB evaluated 494 potential DCD donors, representing over 30% of annual deceased donors.
- 331 (67%) became actual DCD donors, 82 (17%) did not progress, and 81 (16%) transitioned to DBD.
- 276 organs (24 heart, 70 liver, 26 lungs, 12 pancreas) were transplanted from the 81 DBD-transitioned donors.
Conclusions:
- DCD donors are a substantial source of deceased donors.
- Transitioning DCD donors to DBD is a viable strategy to increase organ yield.
- Early communication regarding donation decisions is vital for successful DCD programs.
Abstract:
The clinical characteristics of all New England Organ Bank (NEOB) donors after circulatory death (DCD) donors were analyzed between July 1, 2009, and June 30, 2014. During that 5-year period, there were 494 authorized medically suitable potential DCDs that the NEOB evaluated, constituting more than 30% of deceased donors coordinated annually by the NEOB. From the cohort of 494 authorized potential DCDs, 331 (67%) became actual DCD, 82 (17%) were attempted as a DCD but did not progress to donation, and 81 (16%) transitioned to an actual donor after brain death (DBD). Two hundred seventy-six organs were transplanted from the 81 donors that transitioned from DCD to actual DBD, including 24 heart, 70 liver, 12 single and 14 bilateral lung, and 12 pancreas transplants. When patients with devastating brain injury admitted to the intensive care units are registered donors, the Organ Procurement Organization staff should share the patient's donation decision with the health care team and the patient's family, as early as possible after the comfort measures only discussion has been initiated. The experience of the NEOB becomes an important reference of the successful implementation of DCD that enables an expansion of deceased donation (inclusive of DBD).
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