Purpose: Potential organ donors may be lost if procurement needs to occur emergently due to hemodynamic instability or family request, in particular if serologies and tissue typing are not completed. This series describes the outcomes of 19 donation after cardiac death (DCD) donors who proceeded to procurement less than 8 hours after family consent was obtained.

Methods: This is a retrospective review of 67 donors, comparing 19 donors in the rapid group who went to the OR 8 hours or less from family consent (rDCD) compared to 48 DCD donors in which procurement occurred in the standard time frame (sDCD). Statistical analysis was completed using t-test and chi-square models.

Results: In the rDCD group, 21% (4/19) had tissue typing and 21% (4/19) had serologies at the time of procurement, compared to 100% of the sDCD group. In the rDCD group it took between 5.5 hrs and 25.5 hrs (mean 9hrs) to complete the serologies and 4 hours to 27 hours (mean 9 hrs) to complete tissue typing. Authorization to extubation in the rDCD group occurred between 51 minutes and 7 hours 24 minutes, with a mean of 5 hours and 41 minutes. In the sDCD group, it occurred between 9 hours and 36 minutes to 4 days, 2 hours and 37 minutes (p=< than 0.0001). Once the authorization to extubation occurred, the times from extubation to cardiac time of death (CTOD), CTOD to the incision and flush did not differ between the two groups. Warm ischemic time ranged from 8 to 54 minutes (mean 23 min) in the rDCD group and 14 to 49 min (mean 24 min) (p=0.5654) in the sDCD. In the sDCD group there were 10 livers and 3 en bloc lungs used for transplant, compared to only one liver in the rDCD group. However, in rDCD there were 38 potential kidneys for transplant, and 9 (24%) were discarded. In the sDCD group, a total of 96 kidneys were available for transplant and 14 (15%) were discarded(p=0.2140). In the rDCD group, 9/19 kidneys (47%) had delayed graft function, compared to 22/48 (46%) in the sDCD group (p=1.000). In the rDCD group, all transplanted kidneys were functioning at one year, compared to 7/48 graft losses in the sDCD group (p=0.1784)

Conclusion: Expedited organ recovery can be successful in short time frames and without serologies or tissue typing. Although placement of livers and thoracic organs may be limited, this study demonstrates that kidneys can be recovered and transplanted with excellent one year graft survival.

CITATION INFORMATION: Mekeel K, Trageser J, Garrison W, Berumen J, Stocks L, Hemming A. Rapid Withdrawal of Donation After Cardiac Death Donors. Am J Transplant. 2016;16 (suppl 3).

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