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Updated: Mar 13, 2026
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Positive impact of a clinical goal-directed protocol on reducing cardiac arrests during potential brain-dead donor
Glauco A Westphal1,2,3,4,5,6, Elisabeth Coll7, Rafael L de Souza8
1Central de Transplantes do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil. glauco.w@brturbo.com.br.
Insights
Implementing a goal-directed checklist for potential organ donors significantly reduced cardiac arrests (CA) and increased organ recovery. This quality improvement program enhanced donor management, leading to more successful transplants worldwide.
Area of Science:
- Transplantation Medicine
- Public Health
- Quality Improvement Science
Background:
- Global organ demand significantly outstrips supply, creating a critical public health challenge.
- Reducing organ loss from deceased potential donors, particularly due to cardiac arrest (CA), is crucial for increasing organ availability.
- This study investigated a protocol to minimize CA in potential brain-dead donors (PBDDs).
Purpose of the Study:
- To test the hypothesis that a goal-directed protocol can reduce PBDD losses due to CA.
- To evaluate the effectiveness of a specific checklist in managing potential deceased donors.
- To improve organ donor outcomes and increase transplantation rates.
Main Methods:
- A quality improvement project involving 27 hospitals in Brazil, analyzing deceased donors from May 2012 to April 2014.
- Hospitals utilized the VIP approach checklist, a goal-directed protocol for PBDD management.
- Logistic regression identified predictors of CA, with checklist adherence as a key factor.
Main Results:
- The checklist implementation was associated with a significant reduction in CA (OR 0.43, p<0.001).
- Factors like ICU maintenance and vasopressin administration also correlated with decreased CA.
- CA rates dropped from 27.3% to 14.6% within 24 months, with further decreases observed.
Conclusions:
- A quality improvement program using a goal checklist for potential donor management in the ICU significantly reduces donor losses.
- The program is strongly associated with an increase in organs recovered per donor.
- This approach effectively addresses a critical gap in organ donation and transplantation.
Background:
The disproportion between the large organ demand and the low number of transplantations performed represents a serious public health problem worldwide. Reducing the loss of transplantable organs from deceased potential donors as a function of cardiac arrest (CA) may contribute to an increase in organ donations. Our purpose was to test the hypothesis that a goal-directed protocol to guide the management of deceased donors may reduce the losses of potential brain-dead donors (PBDDs) due to CA.
Methods:
The quality improvement project included 27 hospitals that reported deceased donors prospectively to the Transplant Center of the State of Santa Catarina, Brazil. All deceased donors reported prospectively between May 2012 and April 2014 were analyzed. Hospitals were encouraged to use the VIP approach checklist during the management of PBDDs. The checklist was composed of the following goals: protocol duration 12-24 hours, temperature > 35 °C, mean arterial pressure ≥ 65 mmHg, diuresis 1-4 ml/kg/h, corticosteroids, vasopressin, tidal volume 6-8 ml/kg, positive end-expiratory pressure 8-10 cmH2O, sodium < 150 mEq/L, and glycemia < 180 mg/dl. A logistic regression model was used to identify predictors of CA.
Results:
There were 726 PBDD notifications, of which 324 (44.6) were actual donors, 141 (19.4 %) CAs, 226 (31.1 %) family refusals, and 35 (4.8 %) contraindications. Factors associated with CA reduction included use of the checklist (odds ratio (OR) 0.43, p < 0.001), maintenance performed inside the ICU (OR 0.49, p = 0.013), and vasopressin administration (OR 0.56, p = 0.04). More than three interventions had association with less CAs (OR 0.19, p < 0.001). After 24 months, CAs decreased from 27.3 % to 14.6 % (p = 0.002), reaching 12.1 % in the following two 4-month periods (p < 0.001). Simultaneous increases in organ recovered per donor and in actual donors were observed.
Conclusions:
A quality improvement program based on education and the use of a goal checklist for the management of potential donors inside the ICU is strongly associated with a decrease in donor losses and an increase in organs recovered per donor.
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