Increase in Neurologic Determination of Death (NDD) Organ Donation in the Donation After Circulatory Death (DCD) Era. The Ontario Experience

J. Zaltzman,^1,2 J. MacLean,² C. Payne,² E. Paltser,² V. Rao,³ S. Dhanani.^2,4

¹Medicine, Nephrology & Transplant, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
²Trillium Gift of Life Network, Ontario, Toronto, ON, Canada
³Cardiovascular Surgery and Multi-Organ Transplant, University Health Network, University of Toronto, Toronto, ON, Canada
⁴Pediatric Critical Care, Children's Hospital of Eastern Ontario, Univeristy of Ottawa, Ottawa, ON, Canada.

Meeting: 2015 American Transplant Congress

Abstract number: B84

Keywords: Brain death, Donation, Donors, non-heart-beating

Some jurisdictions have reported a decrease in neurologic determination of death organ donors (NDD) with the implementation of donation after circulatory death (DCD) organ donation. In Ontario, the largest Canadian province that is served by a single OPO, Trillium Gift of Life Network (TGLN), DCD began in 2006. DCD in Ontario, now accounts for >21% of all deceased donor activity, one of the highest rates in North America, and represents >73% of all DCD activity in Canada. We retrospectively examined NDD, DCD organ donation and all solid organ deceased donor transplants during 3 eras: (1) Pre-DCD (2002/3-2005/6), (2) Early DCD(2006/7-2009/10), (3) Recent DCD(2010/11-2013/14). In total organ deceased donation in Ontario increased by 64% from 578 donors in era 1 to 905 donors in Era 3.

Ontario Deceased Donor Activity

3 year period(Fiscal) Year	NDD donors	DCD donors	Total Deceased Donors
Pre DCD(2002/3-2005/6)	578	0	578
Early DCD(2006/7-2009/10)	680	96	776
Recent DCD(2010/11-2013/14)	712	193	905

The average age of NDD donors over the 3 eras were 44.8, 45.2 and 47.0 yrs, compared to 41.8,and 41.4 yrs for DCD donors in the 2 post-DCD eras respectively. Of importance the mean(SD) length of stay before determination of brain death was 2.75(3.34) dys for NDD vs 5.79(3.50) dys to asystolic death in DCD donors. The mean time to asystolic death following withdrawal was 26.13, range(4-93) minutes. Deceased donor transplants increased for all solid organ transplant recipients including heart transplants in the DCD era despite an aging NDD donor population, owing to a modest but concomitant increase in NDD organ donation in Ontario. There was no evidence to suggest that potential NDD donors being "lost" to DCD.

Transplant Activity From Deceased Donors

TRANSPLANTS	KIDNEY+KP+P:NDD/DCD	LIVER:NDD/DCD	LUNG:NDD/DCD	HEART:NDD/DCD	TOTAL:NDD/DCD
Pre DCD	930:930/0	626:626/0	247: 247/0	246:246/0	2049:2049/0
Early DCD	1294:1120/174	645:602/43	367:347/20	263:263/0	2569:2332/237
Recent DCD	1476:1153/323	687:628/59	416:363/53	277:277/0	2856:2421/435

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