Disparities in DCD organ procurement policy from a national OPO survey: A call for standardization

• Published in: Clinical transplantation Vol. 34; no. 4; pp. e13826 - n/a
• Main Authors: Choubey, Ankur Pranjal, Siskind, Eric J., Ortiz, Alex C., Nayebpour, Mehdi, Koizumi, Naoru, Wiederhold, Paul, Ortiz, Jorge
• Format: Journal Article
• Language: English
• Published: Denmark 01.04.2020
• Subjects: asystolic waiting time; pre‐mortem cannulation; rapid laparotomy; vasodilators; warm ischemic time; warm ischemic time; pre-mortem cannulation; rapid laparotomy; asystolic waiting time; vasodilators
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13826

Introduction Procurement practices across organ procurement organizations (OPOs) for donation after cardiac death (DCD) transplants have not been evaluated. Methods A national telephone survey of all 58 OPOs inquiring about their procurement practices of DCD organs was conducted. Policies concerning maximum donor body mass index (BMI), location of care withdrawal, pre‐mortem heparin administration, vasodilator use, wait times after declaration of death before incisions, inclinations between rapid laparotomy and pre‐mortem cannulation, and maximum time before aborting DCD procurement were queried. Results The survey revealed substantial differences across OPOs. Donor BMI restriction was considered by 36 of 58 OPOs, and 23 sites preferred OR for donor withdrawal of care. Pre‐mortem heparin was utilized by 53 OPOs. Only 2 recommended vasodilators. Minimum wait time of 5‐minutes was implemented by 41 OPOs. Rapid laparotomy was preferred by 57 organizations. 28 OPOs had a 90‐minute limit before aborting DCD procurement. Conclusion There are substantial variations across OPO protocols for procuring DCD organs. Current practices do not conform to ASTS guidelines for DCD procurement. Further investigations are needed to quantify the impact of OPO policies on transplant outcomes.