Out-of-Hospital Cardiac Arrest Patients: Different Donor Pathways for an Existing Donor Pool Still...

Area of Science:

• Cardiology
• Transplantation Medicine
• Critical Care Medicine

Background:

• The clinical pathway for patients experiencing cardiac arrest and death is complex, involving various donation types.
• Organ donation pathways include uncontrolled donation after circulatory death (uDCD), controlled donation after circulatory death (cDCD), and donor after brain death (DBD).

Purpose of the Study:

• To review organ donation rates in out-of-hospital cardiac arrest (OHCA) patients across uDCD, cDCD, and DBD categories.
• To explore the potential for expanding each donor pathway in OHCA patients.

Main Methods:

• Systematic review of existing evidence on organ donation rates in OHCA patients.
• Analysis of the feasibility and potential expansion strategies for uDCD, cDCD, and DBD pathways.

Main Results:

• The prevalence of brain death among non-survivor OHCA patients is low and diagnosis is delayed.
• Uncontrolled DCD implementation faces logistical, ethical, and resource challenges but has a strong rationale due to high OHCA incidence and demonstrated feasibility.
• Controlled DCD utilization is estimated around 10% among OHCA patients.

Conclusions:

• All donor pathways (uDCD, cDCD, DBD) in OHCA patients have expansion potential.
• Expansion strategies include better identification of potential donors and improved implementation of DCD programs.