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Updated: Dec 20, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Prediction Model for Timing of Death in Potential Donors After Circulatory Death (DCD III): Protocol for a
Angela M M Kotsopoulos1, Piet Vos2, Nichon E Jansen3
1Department of Intensive Care, Radboudumc, Nijmegen, Netherlands.
Insights
This study develops a prediction model for time to circulatory arrest in potential controlled donation after circulatory death (cDCD) donors. It aims to improve organ transplantation by identifying suitable donors within critical timeframes.
Area of Science:
- Organ transplantation research
- Critical care medicine
- Medical prognostication
Background:
- Controlled donation after circulatory death (cDCD) is vital for organ transplantation.
- Predicting time to circulatory arrest after withdrawal of life-sustaining treatment (WLST) is challenging.
- Previous models lacked generalizability due to non-cDCD patient inclusion.
Purpose of the Study:
- Develop a model to predict death within 60 minutes in potential cDCD patients.
- Validate and update existing prediction models for time to death post-WLST.
- Analyze patient characteristics and timing influencing end-of-life care decisions and organ donation.
Main Methods:
- Multicenter observational prospective cohort study.
- Inclusion of patients meeting cDCD criteria across 3 university and 3 teaching hospitals.
- Application of least absolute shrinkage and selection operator (LASSO) for variable selection in logistic regression modeling.
Main Results:
- Patient enrollment completed in July 2018, with data collection finalized in April 2020.
- Study protocol funded in August 2014, with expected results by July 2020.
- Refitting and updating previous prediction models using LASSO for enhanced accuracy.
Conclusions:
- A robust multimodal prediction model for circulatory arrest time in cDCD donors will be provided.
- The study offers valuable insights into the WLST process for cDCD donors.
- Addresses a critical knowledge gap in organ donation and transplantation.
Background:
Controlled donation after circulatory death (cDCD) is a major source of organs for transplantation. A potential cDCD donor poses considerable challenges in terms of identification of those dying within the predefined time frame of warm ischemia after withdrawal of life-sustaining treatment (WLST) to circulatory arrest. Several attempts have been made to develop models predicting the time between treatment withdrawal and circulatory arrest. This time window determines whether organ donation can occur and influences the quality of the donated organs. However, the selected patients used for these models were not always restricted to potential cDCD donors (eg, patients with cancer or severe infections were also included). This severely limits the generalizability of those data.
Objective:
The objectives of this study are the following: (1) to develop a model predicting time to death within 60 minutes in potential cDCD patients; (2) to validate and update previous prediction models on time to death after WLST; (3) to determine timing and patient characteristics that are associated with prognostication and the decision-making process that leads to initiating end-of-life care; (4) to evaluate the impact of timing of family approach on organ donation approval; and (5) to assess the influence of variation in WLST processes on postmortem organ donor potential and actual postmortem organ donors.
Methods:
In this multicenter observational prospective cohort study, all patients admitted to the intensive care unit of 3 university hospitals and 3 teaching hospitals who met the criteria of the cDCD protocol as defined by the Dutch Transplant Foundation were included. The target of enrolment was set to 400 patients. Previously developed models will be refitted in our data set. To further update previous prediction models, we will apply least absolute shrinkage and selection operator (LASSO) as a tool for efficient variable selection to develop the multivariable logistic regression model.
Results:
This protocol was funded in August 2014 by the Dutch Transplant Foundation. We expect to have the results of this study in July 2020. Patient enrolment was completed in July 2018 and data collection was completed in April 2020.
Conclusions:
This study will provide a robust multimodal prediction model, based on clinical and physiological parameters, that can predict time to circulatory arrest in cDCD donors. In addition, it will add valuable insight in the process of WLST in cDCD donors and will fill an important knowledge gap in this essential field of health care.
Trial Registration:
ClinicalTrials.gov NCT04123275; https://clinicaltrials.gov/ct2/show/NCT04123275.
International Registered Report Identifier (Irrid):
DERR1-10.2196/16733.
