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Original article

Vol. 151 No. 0506 (2021)

Impact of cardiopulmonary resuscitation on organ donation in Switzerland

DOI
https://doi.org/10.4414/smw.2021.20413
Cite this as:
Swiss Med Wkly. 2021;151:w20413
Published
05.02.2021

Summary

AIMS OF THE STUDY

The lack of suitable donor organs limits the number of solid organ transplants. Patients who underwent cardiopulmonary resuscitation (CPR) after cardiac arrest may represent a sizeable subgroup of deceased organ donors, as they often progress to brain death or have life-sustaining therapy withdrawn. We aimed to quantify deceased organ donation after CPR in Switzerland for the first time by analysing the characteristics of potential and utilised organ donors after CPR.

METHODS

Data on deceased adult and paediatric patients who were reported to and approved by Swisstransplant for organ donation were analysed, including both donation after brain death (DBD) and donation after controlled cardiocirculatory death (cDCD) from 2016 to 2018. We analysed baseline characteristics of potential donors who underwent CPR in the context of their hospitalisation, as compared with donors without prior CPR. Considering the varying characteristics between these two donor groups, we assessed the effect of CPR on different allocation outcomes (donor and organ utilisation, organ yield per utilised donor) using multivariable regression. Additionally, we present selected CPR circumstances and compared different subgroups of CPR donors according to duration of CPR and duration of no-flow time.

RESULTS

Of the 461 deceased potential organ donors included in the analysis, 173 (37.5%) underwent CPR. CPR donors were, on average, younger (median age 53 vs 62, p <0.001), had different causes of death (p <0.001), and were more often of the cDCD type (30.1% vs 18.4%, p = 0.004) as compared with non-CPR donors. Of the 173 CPR donors, 152 (87.9%) could be utilised (minimum one organ transplanted), and in the multivariable analysis, utilisation rate was higher in the CPR donor group than in the non-CPR donor group (odds ratio 3.3, 95% confidence interval 1.1–11.5; p = 0.046). Organ specific utilisation of heart, liver, and kidney, and total organ yield per donor, did not differ significantly between CPR and non-CPR donors.

CONCLUSION

Our study reveals that a substantial proprotion of deceased organ donors in Switzerland underwent CPR in context of their hospitalisation. CPR donors are different from non-CPR donors with respect to age, cause of death and donation type. However, when carefully selected according to their haemodynamic condition, CPR donors are comparable to non-CPR donors in terms of donor and organ utilisation, as well as the average organ yield. Thus, all patients who are resuscitated from cardiac arrest but who subsequently progress to death should be evaluated for organ donation. How CPR donors compare with non-CPR donors regarding transplant outcomes should be studied further.

References

  1. Goetzmann L, Sarac N, Ambühl P, Boehler A, Irani S, Muellhaupt B, et al. Psychological response and quality of life after transplantation: a comparison between heart, lung, liver and kidney recipients. Swiss Med Wkly. doi:https://doi.org/smw.2008.12160. 2008;138(33-34):477–83.
  2. Global Observatory on Donation and Transplantation (GODT). Organ Donation and Transplantation Activities 2017 Report [Internet]. 2019 Oct. Available from: http://www.transplant-observatory.org/wp-content/uploads/2019/11/glorep2017.pdf
  3. Swisstransplant. Jahresbericht 2019 [2019 annual report] [Internet]. Bern, Switzerland: Swisstransplant, the Swiss National Foundation for organ donation and transplantation; 2020 Apr. Available from: https://www.swisstransplant.org/fileadmin/user_upload/Swisstransplant/Jahresbericht/2019/Swisstransplant-Jahresbericht_2019.pdf
  4. Loupy A, Aubert O, Reese PP, Bastien O, Bayer F, Jacquelinet C. Organ procurement and transplantation during the COVID-19 pandemic. Lancet. 2020;395(10237):e95–6. Accessed May 14, 2020 ].https://doi.org/10.1016/S0140-6736(20)31040-0
  5. Cypel M, Keshavjee S. Strategies for safe donor expansion: donor management, donations after cardiac death, ex-vivo lung perfusion. Curr Opin Organ Transplant. 2013;18(5):513–7 ].https://doi.org/10.1097/MOT.0b013e328365191b
  6. EDQM. Guide to the quality and safety of organs for transplantation [Internet]. European Directorate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM); 2018. Available from: www.edqm.eu
  7. Elmer J, Molyneaux BJ, Shutterly K, Stuart SA, Callaway CW, Darby JM, et al. Organ donation after resuscitation from cardiac arrest. Resuscitation. 2019;145:63–9 ].https://doi.org/10.1016/j.resuscitation.2019.10.013
  8. West S, Soar J, Callaway CW. The viability of transplanting organs from donors who underwent cardiopulmonary resuscitation: A systematic review. Resuscitation. 2016;108:27–33 ].https://doi.org/10.1016/j.resuscitation.2016.07.229
  9. Kiguchi T, Okubo M, Nishiyama C, Maconochie I, Ong MEH, Kern KB, et al. Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation. 2020;152:39–49 ].https://doi.org/10.1016/j.resuscitation.2020.02.044
  10. R Core Team. R: A language and environment for statistical computing. [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2017. Available from: https://www.R-project.org/
  11. Hinzmann J, Grzella S, Lengenfeld T, Pillokeit N, Hummels M, Vaihinger H-M, et al. Impact of donor cardiopulmonary resuscitation on the outcome of simultaneous pancreas-kidney transplantation-a retrospective study. Transpl Int. 2020;33(6):644–56 ].https://doi.org/10.1111/tri.13588
  12. Galeone A, Varnous S, Lebreton G, Barreda E, Hariri S, Pavie A, et al. Impact of cardiac arrest resuscitated donors on heart transplant recipients’ outcome. J Thorac Cardiovasc Surg. 2017;153(3):622–30 ].https://doi.org/10.1016/j.jtcvs.2016.10.079
  13. Mehdiani A, Immohr MB, Sipahi NF, Boettger C, Dalyanoglu H, Scheiber D, et al. Successful Heart Transplantation after Cardiopulmonary Resuscitation of Donors. Thorac Cardiovasc Surg. 2020:s-0040–1713351. doi:https://doi.org/10.1055/s-0040-1713351.
  14. Cohen J, Bistritz Y, Ashkenazi T. Deceased Organ Donor Characteristics and Organ Utilization in Israel, 2004-2013. Isr Med Assoc J. 2015;17(6):365–9.
  15. Sandroni C, D’Arrigo S, Callaway CW, Cariou A, Dragancea I, Taccone FS, et al. The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis. Intensive Care Med. 2016;42(11):1661–71 ].https://doi.org/10.1007/s00134-016-4549-3
  16. Selck FW, Deb P, Grossman EB. Deceased organ donor characteristics and clinical interventions associated with organ yield. Am J Transplant. 2008;8(5):965–74 ].https://doi.org/10.1111/j.1600-6143.2008.02205.x
  17. Swiss Academy of Medical Sciences (SAMS). Determination of Death with Regard to Organ Transplantation and Preparations for Organ Removal. SAMS;2017. p. 34.
  18. Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, et al. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation [Internet]. 2020 Oct 20 [cited 2020 Nov 5];142(16_suppl_2). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000899
  19. Messner F, Etra JW, Yu Y, Massie AB, Jackson KR, Brandacher G, et al. Outcomes of simultaneous pancreas and kidney transplantation based on donor resuscitation. Am J Transplant. 2020;20(6):1720–8 ].https://doi.org/10.1111/ajt.15808