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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

01.07.2011 | Reports of Original Investigations

Organ donation after cardiac death: donor and recipient outcomes after the first three years of the Ontario experience

verfasst von: Roberto Hernadez-Alejandro, MD, William Wall, MD, Anthony Jevnikar, MD, Patrick Luke, MD, Michael Sharpe, MD, David Russell, MD, Azeem Gangji, MD, Edward Cole, MD, Sang Joseph Kim, MD, PhD, Marcus Selzner, MD, Shaf Keshavjee, MD, Dianne Hebert, MD, G. V. Ramesh Prasad, MD, Andrew Baker, MD, Greg Knoll, MD, Robyn Winterbottom, BSc, Guiseppe Pagliarello, MD, Clare Payne, BSc, Jeff Zaltzman, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 7/2011

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Abstract

Purpose

The aim of this study was to explore donor and recipient outcomes from organ donation after cardiac death (DCD) in Ontario and to examine the impact of DCD on deceased donation rates in Ontario since its implementation.

Methods

Donor data were obtained from the Trillium Gift of Life Network (TGLN) TOTAL database from June 1, 2006 until May 31, 2009. All DCDs were tracked, including unsuccessful DCD attempts during that time. For the first 36 months after DCD implementation, all Ontario solid organ transplant programs that utilized organs from DCD provided clinical outcome data at one year. Total DCD activity until December 1, 2010 was also tracked. In addition, we compared organ donation and DCD rates across all Canadian jurisdictions and the USA.

Results

For the first 36 months of DCD activity in Ontario, June 1, 2006 to May 31, 2009, there were 67 successful DCDs out of 87 attempted DCDs in 18 Ontario hospitals, resulting in 128 kidney, 41 liver, and 21 lung transplants. The one-year kidney patient and death-censored allograft survivals were 96 and 97%, respectively. Mean (SD) creatinine at 12 months was 150 (108) μmol·L⁻¹. In 26 (20%) extended criteria donors (ECD-DCD), the one-year creatinine was 206 (158) μmol·L⁻¹ vs 137 (80) μmol·L⁻¹ in 102 standard criteria donors (SCD-DCD) (P = 0.002). The one-year liver and lung allograft survivals were 78% and 70%, respectively. Since its implementation four and a half years ago, DCD has accounted for 10.9% of deceased donor activity in Ontario. In 2009, Ontario had a record number of organ donors. Of the 221 deceased donors, 37 (17%) donors were DCD. By December 1, 2010 there were 121 DCD Ontario donors resulting in > 300 solid organ transplants and accounting for 90% of all DCD activity in the country.

Conclusion

The rapid update of DCD in Ontario can be attributed to strong proponents in the critical care and transplantation communities with continued support from Trillium Gift of Life Network (TGLN). Ontario is the only province to demonstrate growth in deceased donor rates over the last decade (25% over the last four years), which can be attributed primarily to the success of its DCD activity.

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Titel: Organ donation after cardiac death: donor and recipient outcomes after the first three years of the Ontario experience
verfasst von: Roberto Hernadez-Alejandro, MD
William Wall, MD
Anthony Jevnikar, MD
Patrick Luke, MD
Michael Sharpe, MD
David Russell, MD
Azeem Gangji, MD
Edward Cole, MD
Sang Joseph Kim, MD, PhD
Marcus Selzner, MD
Shaf Keshavjee, MD
Dianne Hebert, MD
G. V. Ramesh Prasad, MD
Andrew Baker, MD
Greg Knoll, MD
Robyn Winterbottom, BSc
Guiseppe Pagliarello, MD
Clare Payne, BSc
Jeff Zaltzman, MD
Publikationsdatum: 01.07.2011
Verlag: Springer New York
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 7/2011
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-011-9511-9

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Organ donation after cardiac death: donor and recipient outcomes after the first three years of the Ontario experience