Non-heart-beating organ donors as a source of kidneys for transplantation:a chart review

Background: Organ transplantation is the treatment of choice for patients w ith endstage organ failure, but the supply of organs has not increased to m eet demand. This study was undertaken to determine the potential for kidney donation from patients with irremediable brain injuries who do not meet th e criteria for brain death and who experience cardiopulmonary arrest after withdrawal of ventilatory support (controlled non-heart-beating organ donor s). Methods: The charts of 209 patients who died during 1995 in the Emergency D epartment and the intensive care unit at the Foothills Hospital in Calgary were reviewed. The records of patients who met the criteria for controlled non-heart-beating organ donation were studied in detail. The main outcome m easure was the time from discontinuation of ventilation until cardiopulmona ry arrest. Results: Seventeen potential controlled non-heart-beating organ donors were identified. Their mean age was 62 (standard deviation 19) years. Twelve of the patients (71%) had had a cerebrovascular accident, and more than half (10 [59%]) did not meet the criteria for brain death because one or more br ain stem reflexes were present. At the time of withdrawal of ventilatory su pport, the mean serum creatinine level was 71 (29) mu mol/L, mean urine out put was 214 (178) mL/h, and 9 (53%) patients were receiving inotropic agent s. The mean time from withdrawal of ventilatory support to cardiac arrest w as 2.3 (5.0) hours; 13 of the 17 patients died within 1 hour, and all but o ne died within 6 hours. For the year for which charts were reviewed, 33 pot ential conventional donors (people whose hearts were beating) were identifi ed, of whom 21 (64%) became donors. On the assumption that 40% of the poten tial controlled non-heart-beating donors would not in fact have been donors (25% because of family refusal and 15% because of nonviability of the orga ns), there might have been 10 additional donors, which would have increased the supply of cadaveric kidneys for transplantation by 48%. Interpretation: A significant number of viable kidneys could be retrieved a nd transplanted if eligibility for kidney donation was extended to include controlled non-heart-beating organ donors.