Prediction on Time to Death in Potential Controlled Donation After Circulatory Death (cDCD) Donors (DCD III Study)
Condition: Tissue and Organ Procurement
MeSH terms: Death
Study type: Observational

Summary: 
      A considerable number of potential cDCD donors do not convert into actual organ donors
      because circulatory arrest does not occur within the predefined timeframe of warm ischemia
      after withdrawal of life-sustaining treatment. The main objective of this study is to
      determine parameters predicting time to death in potential cDCD patients.
    

Detailed description: 
      Controlled donation after circulatory death (cDCD) is a major source of organs for
      transplantation. Even though there is a well-established cDCD program in the Netherlands,
      there is still a considerable number of potential donors not being converted into actual
      organ donors. A potential cDCD donor poses considerable challenges in terms of a)
      identification of those dying within the predefined timeframe of warm ischemia, after
      withdrawal of life-sustaining treatment to circulatory arrest, b) managing them appropriately
      within the framework and resources of the intensive care unit, c) dealing with family
      expectations especially when failure to donation occurs, and d) efficient utilization of the
      organ procurement teams.

      Factors associated with early circulatory collapse after treatment withdrawal include a
      younger age, non-triggered modes of artificial ventilation, high FiO2, the use of inotropes,
      and a low arterial pH. Another important factor which could influence the donor potential is
      end-of-life treatment. The practice of withdrawal of life support treatment (WLST) is highly
      variable between ICU's and countries. This influences the dying process and can thus have a
      large influence on the onset of cardio respiratory arrest. There is also wide variation in
      the use and dosage of additional sedation and analgesia during WLST and controversy exists
      regarding hastening or slowing down death.

      Several attempts have been made to develop models to predict the time between treatment
      withdrawal and circulatory arrest, as this is crucial to a) proceed with organ donation, and
      b) the quality of the harvested organs. The selected patients however, where not always
      restricted to potential candidates for cDCD organ donation as patients with cancer and severe
      infection were also included.

      Objective: Objectives of this study are: a) To determine parameters predicting time to death
      in potential cDCD patients b) To validate and update previous predicting models on time to
      death after withdrawal of life-sustaining treatment. c) To assess variation in withdrawal of
      life-sustaining treatment in the Netherlands and its influence on post mortal organ donor
      potential and actual post mortal organ donors.

      Design and setting: Multicenter, observational, prospective cohort study of all potential
      cDCD patients of 3 university and 3 teaching hospitals in the Netherlands with diverse focus
      of attention

      Methods: All potential cDCD patients participating in the cDCD protocol as defined by the
      Dutch Transplant Foundation admitted at the Intensive Care unit, will be included.

      Participants: Mechanically ventilated ICU patients aged between 18 to 75 years. Brain dead
      patients will be excluded.
    

Intervention name(s): No intervention wil be done. Patient characteristics and the standard care before and after withdrawal of life-sustaining treatment in all potential cDCD donors, will be studied. .
Intervention type(s): Other
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All mechanically ventilated patients admitted at the Intensive Care Unit, aged between 18
        and 75 years old who are eligible to enter the organ procurement protocol of the Dutch
        Transplant Foundation.
      
Keywords: Validation studies; Withholding treatment