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Updated: Jun 24, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Potential for organ donation after controlled circulatory death: a retrospective analysis
Francisco Santos Dias1,2, Diana Martins Fernandes1, António Cardoso-Fernandes3,4,5
1Department of Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal.
Insights
Implementing controlled circulatory death donation in Portugal could increase organ donation by 10 donors annually, boosting transplantation activity by 21%. This approach offers significant public health benefits and ethical alignment for end-of-life care.
Area of Science:
- Medical Ethics
- Transplantation Medicine
- Intensive Care Medicine
Background:
- Portugal faces a significant gap between organ demand and availability for transplantation.
- Controlled circulatory death donation has not yet been implemented in Portugal.
Purpose of the Study:
- To estimate the potential increase in organ donation by implementing a controlled circulatory death donation program in Portugal.
- To assess the impact on transplantation activity.
Main Methods:
- Retrospective analysis of all deceased patients in an intensive care unit in 2019.
- Estimation of potential organ donor gain by comparing eligible cases with actual donors.
- Statistical analysis using t-tests, Mann-Whitney U tests, and chi-squared tests.
Main Results:
- 10 out of 152 deaths after withdrawal of life-sustaining therapies were potentially eligible for controlled circulatory death donation.
- This could lead to 10 additional donors, a 21% increase in yearly transplantation activity, particularly for kidney transplants.
- Longer intervals between withdrawal of support and death were noted, partly due to documentation variations.
Conclusions:
- Controlled circulatory death donation offers substantial public health benefits.
- Implementing this donation method aligns with ethical principles for end-of-life care.
- Legislation enabling this donation strategy represents a social gain, allowing more patients to donate organs.
Objectives:
Despite the discrepancy between demand and availability of organs for transplantation, controlled circulatory death donation has not been implemented in Portugal. This study aimed to estimate the potential increase in organ donation from implementing such a program.
Material And Methods:
All deceased patients within the intensive care medicine department at Centro Hospitalar Universitário de São João, throughout the year 2019, were subjected to retrospective analysis. Potential gain was estimated comparing the results with the number of donors and organs collected during the same period at this hospital center. Differences in variables between groups were assessed using t tests for independent samples or Mann-Whitney U tests for continuous variables, and chi-squared tests were used for categorical variables.
Results:
During 2019, 152 deaths occurred after withdrawal of life-sustaining therapies, 10 of which would have been potentially eligible for donation after controlled circulatory death. We can anticipate a potential increase of 10 prospective donors, a maximum 21% growth in yearly transplantation activity, with a greater impact on kidney transplantation. For most patients, the time between withdrawal of organ support and death surpassed 120 minutes, an outcome explained by variations in withdrawal of life-sustaining measures and insufficient clinical records, underestimating the potential for controlled circulatory arrest donation.
Conclusion:
This study effectively highlights public health benefits of controlled circulatory arrest donation. Legislation allowing donation through this method represents a social gain and enables patients who will never meet brain death criteria to donate organs as part of the end-of-life process in intensive care medicine, within a framework of complete ethical alignment.
