Who should be considered for Maastricht 3 DCD? · 2017. 3. 29. · Paul Murphy, Joanne Allen, Alex...
1
1213 330 Maastricht A0 poster - Paul Murphy Who should be considered for Maastricht 3 DCD? Paul Murphy, Joanne Allen, Alex Manara and Dale Gardiner NHS Blood and Transplant, Bristol, UK, BS34 8RR Introduction Controlled DCD has increased tenfold in the UK over the last decade. (The number of DCD donors in the UK from 1 April 2001 to 31 March 2012 is shown in Figure 1). Many consider this form of donation to occur after patients die with severe brain injury, but other patients may also be suitable. 42 61 73 87 127 159 200 288 335 373 436 0 50 100 150 200 250 300 350 400 450 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 Year Number of DCD donors Figure 1 Number of deceased donors after circulatory death (DCD) in the UK, April 2001 to March 2012 Methods and Results Patients for whom imminent death was anticipated and treatment was withdrawn with no absolute or relative medical contraindications to solid organ donation, ie potential DCD (n=7504), and those who became actual DCDs (n=877) between 1 October 2009 and 31 March 2012 were identified from the UK Potential Donor Audit (PDA). The PDA collects information on patient deaths in ICUs and emergency departments but excludes cardiothoracic ICUs. Patients aged 76 years or over are also excluded from the national audit criteria. The diagnostic categories are presented in Figure 2. 10.4 16.2 12.4 25.9 3.2 5.6 26.3 3.5 4.2 6.2 27.5 7.8 8.0 42.8 0 5 10 15 20 25 30 35 40 45 Other Miscellaneous Other Medical Disease Primary Respiratory Disease Hypoxic Brain Injury Trauma (including head injury) Other CVA (thrombotic or unclassified) Intracranial haemorrhage (non traumatic) Percentage Actual DCDs % Potential DCDs % Figure 2 Diagnostic categories for all potential DCDs (n=7504) and those who became actual DCDs (n=877) between October 2009 and March 2012. Data from Potential Donor Audit (courtesy of NHSBT) Conclusion While brain injury is by far the most common diagnosis in actual DCDs, primary respiratory disease and other non- neurological diagnosis make a significant contribution (13.9%) to DCD number. Although patients with hypoxic brain injury have previously been considered to have a low potential for DCD because of the presence of contraindications to transplantation 1 such patients accounted for 241 of a total of 877 donors The potential for DCD should be considered in any patient having treatment withdrawn irrespective of the diagnosis. References 1. Gratrix AP, Pittard AJ, Bodenham AR. Outcome after admission to ITU following out-of-hospital cardiac arrest: are non-survivors suitable for non-heart beating organ donation? Anaesthesia2007; 62: 434–7. 1213 330 Maastricht A0poster.indd 1 26/09/2012 11:44:32
Transcript of Who should be considered for Maastricht 3 DCD? · 2017. 3. 29. · Paul Murphy, Joanne Allen, Alex...
1213 330 Maastricht A0 poster - Paul Murphy
Who should be considered for Maastricht 3 DCD?
Paul Murphy, Joanne Allen, Alex Manara and Dale Gardiner NHS Blood and Transplant, Bristol, UK, BS34 8RR
IntroductionControlled DCD has increased tenfold in the UK over the last decade. (The number of DCD donors in the UK from 1 April 2001 to 31 March 2012 is shown in Figure 1). Many consider this form of donation to occur after patients die with severe brain injury, but other patients may also be suitable.
4261 73
87
127
159
200
288
335
373
436
0
50
100
150
200
250
300
350
400
450
2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
Year
Num
ber o
f DC
D d
onor
s
Figure 1 Number of deceased donors after circulatory death (DCD) in the UK, April 2001 to March 2012
Methods and ResultsPatients for whom imminent death was anticipated and treatment was withdrawn with no absolute or relative medical contraindications to solid organ donation, ie potential DCD (n=7504), and those who became actual DCDs (n=877) between 1 October 2009 and 31 March 2012 were identifi ed from the UK Potential Donor Audit (PDA). The PDA collects information on patient deaths in ICUs and emergency departments but excludes cardiothoracic ICUs. Patients aged 76 years or over are also excluded from the national audit criteria.
The diagnostic categories are presented in Figure 2.
10.4
16.2
12.4
25.9
3.2
5.6
26.3
3.5
4.2
6.2
27.5
7.8
8.0
42.8
0 5 10 15 20 25 30 35 40 45
Other Miscellaneous
Other Medical Disease
Primary Respiratory Disease
Hypoxic Brain Injury
Trauma (including head injury)
Other CVA (thrombotic or unclassified)
Intracranial haemorrhage (non traumatic)
Percentage
Actual DCDs %
Potential DCDs %
Figure 2 Diagnostic categories for all potential DCDs (n=7504) and those who became actual DCDs (n=877) between October 2009 and March 2012. Data from Potential Donor Audit (courtesy of NHSBT)
ConclusionWhile brain injury is by far the most common diagnosis in actual DCDs, primary respiratory disease and other non-neurological diagnosis make a signifi cant contribution (13.9%) to DCD number. Although patients with hypoxic brain injury have previously been considered to have a low potential for DCD because of the presence of contraindications to transplantation1 such patients accounted for 241 of a total of 877 donors The potential for DCD should be considered in any patient having treatment withdrawn irrespective of the diagnosis.
References1. Gratrix AP, Pittard AJ, Bodenham AR. Outcome after admission to ITU
following out-of-hospital cardiac arrest: are non-survivors suitable for non-heart beating organ donation? Anaesthesia2007; 62: 434–7.
1213 330 Maastricht A0poster.indd 1 26/09/2012 11:44:32
