Three Criteria Can Identify Out-of-Hospital Cardiac Patients for Potential Organ Donation

Three objective criteria could identify out-of hospital  ‏cardiac arrest (OHCA) patients with ‏zero chance of survival, who can be considered ‏for organ donation. Prof. Xavier Jouven, Georges ‏Pompidou European Hospital, Paris, and ‏colleagues, analysed data from two registries and ‏a clinical trial, and found that there is essentially ‏no chance of survival in patients whose OHCA ‏is not witnessed by emergency medical services ‏personnel, who have nonshockable initial cardiac ‏rhythm, and in whom spontaneous circulation ‏does not return before receipt of a third 1-mg ‏dose of epinephrine (Jabre et al. 2016).

Prof. Jouven (pictured) told ICU Management & Practice that he ‏would like these results to contribute to elaborating ‏new recommendations about out-of-hospital ‏cardiac arrest patients. "We are aware there is a ‏psychological barrier, but the possibility to collect ‏organs from a proportion of those cardiac arrests ‏represents an important opportunity to fill the ‏gap of organ shortage,” he said.

Existing termination-of-resuscitation rules ‏help to identify cases where further resuscitation ‏is futile, but do not take into consideration the ‏potential utility of transporting dead patients to ‏the hospital for organ donation. Applying the three ‏criteria to the validation cohorts, the researchers ‏found that between 8 and 12% of patients  with no chance of survival might have had organs ‏that were potentially suitable for transplantation. ‏They applied the eligibility criteria used in France ‏for kidney retrieval from uncontrolled donation ‏after cardiac death (UDCD). Jouven said that they ‏considered this new approach first for kidney ‏donation. In Europe kidney allograft represents ‏60% of all allografts, with 15,000 new grafts per ‏year. In future this early identification may be ‏applied for other organ donation (liver, cornea), ‏he added.

The researchers acknowledge that their results ‏may be overestimates, as some UDCD eligibility ‏criteria may be difficult to verify at the OHCA ‏scene. They recommend that emergency medical ‏services develop protocols and implementation ‏plans with their organ donation programmes to ‏optimise donation after OHCA, and implement ‏these three objective criteria in their protocols for ‏cardiac arrest. “Rapid referral to an organ donation ‏institution under mechanical ventilation and ‏continuous automated external cardiac massage ‏should be considered for patients with no chance ‏of survival,” they write.