Roberto Hernadez-Alejandro1, William Wall1, Anthony Jevnikar1, Patrick Luke1, Michael Sharpe2, David Russell3, Azeem Gangji3, Edward Cole4, Sang Joseph Kim4, Marcus Selzner4, Shaf Keshavjee4, Dianne Hebert5, G V Ramesh Prasad6, Andrew Baker7, Greg Knoll8, Robyn Winterbottom9, Guiseppe Pagliarello10, Clare Payne11, Jeff Zaltzman12,13. 1. Multi-Organ Transplant Program, London Health Science Centre, London, ON, Canada. 2. Department of Critical Care, London Health Science Centre, London, ON, Canada. 3. Division of Nephrology, Department of Medicine, St. Joseph's Hospital, Hamilton, ON, Canada. 4. Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada. 5. Kidney Transplant Program, Hospital for Sick Children, Toronto, ON, Canada. 6. Division of Nephrology, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 7. Department of Anesthesia, Li Ka Shing Knowledge Institute, Cara Phelan Centre for Trauma Research, St. Michael's Hospital, Toronto, ON, Canada. 8. Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, USA. 9. University of Ottawa Medical School, Ottawa, ON, USA. 10. Department of Critical Care, The Ottawa Hospital, Ottawa, ON, USA. 11. Trillium Gift of Life Network, Toronto, ON, Canada. 12. Trillium Gift of Life Network, Toronto, ON, Canada. jeffrey.zaltzman@utoronto.ca. 13. Division of Nephrology, Department of Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 61 Queen St. East, Room 9-118, Toronto, ON, M5C 2T2, Canada. jeffrey.zaltzman@utoronto.ca.
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.
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.
Authors: Malcolm Wells; Kris M Croome; Toni Janik; Roberto M Hernandez-Alejandro; Natasha M Chandok Journal: Can J Gastroenterol Hepatol Date: 2013-11-28
Authors: Huzaifa I Adamali; Eoin P Judge; David Healy; Lars Nolke; Karen C Redmond; Waldemar Bartosik; Jim McCarthy; Jim J Egan Journal: BMJ Open Date: 2012-03-28 Impact factor: 2.692
Authors: Aric Bendorf; Patrick J Kelly; Ian H Kerridge; Geoffrey W McCaughan; Brian Myerson; Cameron Stewart; Bruce A Pussell Journal: PLoS One Date: 2013-05-07 Impact factor: 3.240