Attempts at donation after cardiac death (DCD) lead to organ transplantation only among 70% of eligible DCDs. Imminent death donation (IDD) is ante-mortem donation of organs from individuals who would be eligible for DCD. However, IDD is not practiced in the United States due to regulatory barriers, ethical concerns and uncertainty about effects on the organ supply. Using published data and national data sources to guide our assumptions, we modeled the change in the number of organs recovered, graft quality measured by kidney donor risk index (KDRI), delayed graft function (DGF) and acute rejection if DCD were allowed. We compared 4 scenarios: 1) all DCD-eligible donors attempt DCD, 2) Change in practice favors IDD of only 1 kidney and a liver lobe, 3) Change in practice favors IDD of a single kidney, followed by attempted DCD recovery of the second kidney and liver after declaration of death, 4) Change in practice favors IDD of 2 kidneys and liver lobe at the same time. For every 500 DCD eligible donors (1000 potential kidneys), we find that a practice of IDD where both kidneys were recovered (Option 4) would have the highest kidney recovery (1000 vs. 700 for DCD), but would result in fewer liver donations (75 vs. 87 for DCD). As compared to DCD, all IDD scenarios had lower rate of biopsy proven acute kidney rejection (Option 4; 15.9 vs. 28.1% for DCD) and instances of delayed graft function (Option 4; 21 vs. 40%). If DCD were to be replaced with IDD, we estimate that kidney graft survival would increase by 1.4% at the end of 3 years of transplantation. IDD might provide donors and their surrogates an alternative form of donating an organ. Additionally, donors who might have never been eligible to donate as DCD might be eligible to donate under IDD, potentially increasing the pool of available donors.

CITATION INFORMATION: Potluri V, Nazarian S, Levine M, Reese P. Imminent Death Donation: Potential Effects on Organ Donation Numbers and Clinical Outcomes. Am J Transplant. 2016;16 (suppl 3).

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