We wished to evaluate in detail those DCD cases in which our OPO did not pursue organ donation but the potential DCD candidate expired within the acceptable time frame for donation. We called these missed donor opportunities “false negative (FN)” donors, as opposed to those DCD donors who we did believe would expire and organs were procured (true positives (TP)).

METHODS: A retrospective review was performed of all potential DCD cases in our OPO from January 2012 to April 2015. Any patient who expired greater than 30 mins after withdrawal of life sustaining measures was excluded from analysis. This left 20 potential donors whom the OPO did not think would expire but did (FN), and 146 DCD donors whom the OPO thought would expire within 30 mins and indeed did (TP). Demographics, as well as clinical and laboratory data were reviewed and statistically analyzed.

RESULTS: In the FN group, there were more African Americans than in the TP group, and the average age was greater (51 yrs), than in the TP group (40 yrs). The BMI for the FN group was 28.7, vs 30.7 for the TP donors. In terms of cause of death, only 5.0% of the FN died from cardiovascular causes, vs 19.2% in the TP group. Stroke/CVA was a cause in 25.0% of the FN, vs 11.0% in the TP. Anoxia and trauma as cause of death were similar in both groups. The terminal P/F oxygenation ratios were similar in both FN and TP groups, 277.5 and 253.1, respectively. However, there were considerable differences noted in the neurologic flexes between the groups of potential DCD donors. No pupil, cough, gag, corneal and pain reflexes were found in 20.0, 10.0, 35.0, 45.0 and 55.0% of the FN group, vs 57.5, 56.1, 70.6, 42.5, and 56.1% in the TP donor group. 95.0% of the patients in the FN group were noted to breathe over the ventilator, whereas that was the case in only 55.5% for the TP DCD organ donors.

CONCLUSIONS: Despite that a majority of the false negative potential DCD donors had pupillary, cough, and gag reflexes, as well as were breathing over the ventilator, they still expired within 30 mins of extubation. These were real missed opportunities to realize donor organs. It would be ideal to have effective tools to predict whether a patient will reach circulatory death within the acceptable time period for DCD organ donation, but that is not the case at this time. We thus advocate that all potential DCD cases must be aggressively pursued by OPOs.

CITATION INFORMATION: Rudich S, Messer R, Pietroski R, Lange P. Missed Opportunities After Cardiac Death: Should Every Donation After Cardiac Death (DCD) Referral Be Pursued? A Large Single US Organ Procurement Organization (OPO) Experience. Am J Transplant. 2016;16 (suppl 3).

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