Stephen P Wall1, Bradley J Kaufman2, Nicholas Williams3, Elizabeth M Norman4, Alexander J Gilbert5, Kevin G Munjal6, Shana Maikhor3, Michael J Goldstein7, Julia E Rivera8, Harvey Lerner8, Chad Meyers1, Marion Machado1, Susan Montella1, Marcy Pressman9, Lewis W Teperman10, Nancy N Dubler11, Lewis R Goldfrank12. 1. Bellevue Hospital Center, New York, NY; Department of Emergency Medicine, NYU School of Medicine, New York, NY. 2. Fire Department of the City of New York, New York, NY, and the Department of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY. 3. Department of Emergency Medicine, NYU School of Medicine, New York, NY. 4. NYU Steinhardt School of Culture, Education, and Human Development, New York, NY. 5. MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC. 6. Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY. 7. Department of Surgery, University of Miami Miller School of Medicine, Miami, FL. 8. LiveOnNY, New York, NY (formerly the New York Organ Donor Network). 9. Bellevue Hospital Center, New York, NY. 10. Department of Surgery, NYU School of Medicine, New York, NY; NYU Organ Transplant Center, NYU School of Medicine, New York, NY. 11. Department of Population Health, Division of Medical Ethics, NYU School of Medicine, New York, NY. 12. Bellevue Hospital Center, New York, NY; Department of Emergency Medicine, NYU School of Medicine, New York, NY. Electronic address: lewis.goldfrank@nyumc.org.
Abstract
STUDY OBJECTIVE: In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. METHODS: We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. RESULTS: The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%). CONCLUSION: In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.
STUDY OBJECTIVE: In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. METHODS: We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. RESULTS: The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%). CONCLUSION: In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.
Authors: Brendan Parent; Arthur Caplan; Luis Angel; Zachary Kon; Nancy Dubler; Lewis Goldfrank; Jacob Lindner; Stephen P Wall Journal: Am J Transplant Date: 2019-10-18 Impact factor: 8.086
Authors: Frederick D'Aragon; Olivier Lachance; Vincent Lafleur; Ivan Ortega-Deballon; Marie-Helene Masse; Gabrielle Trepanier; Daphnee Lamarche; Marie-Claude Battista Journal: Open Access Emerg Med Date: 2022-08-05