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Expedited organ donation in Victoria, Australia: donor characteristics and donation outcomes
Rohit L D'Costa, Samuel Radford, Helen I Opdam, Mark McDonald, Leanne McEvoy, Rinaldo Bellomo
Crit Care Resusc 2020; 22 (4): 303-311
- Rohit L D'Costa 1, 2
- Samuel Radford 1, 3, 4
- Helen I Opdam 3, 5
- Mark McDonald 5
- Leanne McEvoy 1
- Rinaldo Bellomo 2, 3, 4
Rohit D’Costa, Samuel Radford and Leanne McEvoy are employees of DonateLife Victoria (part of Australian Red Cross LifeBlood), which coordinates organ and tissue donation in the State of Victoria, Australia. Helen Opdam is an employee of the Organ and Tissue Authority, which is an independent statutory agency within the Australian Government Health portfolio
BACKGROUND: Deceased organ donation work-up typically takes 24 hours or more. Clinicians may thus discount the possibility of donation when the potential donor is physiologically unstable or family requirements do not allow this length of time. This may lead to loss of transplantable organs. In 2015, we introduced an expedited work-up guideline with the aim of facilitating donation in these circumstances and maximising donation potential.
OBJECTIVE: To determine the number of expedited work-up (consent to retrieval procedure of 6 hours or less) donors from 2015 to 2018, compare their clinical and demographic characteristics with standard donors, and assess the outcome of transplanted organs and organ recipients.
DESIGN: We performed a retrospective audit of the electronic database for all Victorian donors from 2015 to 2018. We obtained transplant outcome data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).
RESULTS: Overall, 38 expedited pathway donors donated 78 organs for transplantation (70 kidneys, four lungs, three livers, one pancreas). Of these, 55 retrieved kidneys were successfully transplanted. The lungs, livers and pancreas retrieved were all transplanted. For the kidney recipients, early graft dysfunction requiring dialysis was more common than with organs from the standard pathway (71% v 38%; P < 0.0001); however, short and medium term graft and patient survival were similar. Three recipients from the expedited pool experienced graft failure and two subsequently died. Of the two lung recipients, one died at day 622 of chronic rejection.
CONCLUSIONS: Expedited pathway donation is feasible with acceptable donation outcomes. Clinicians should consider donation even when physiological instability or family requirements preclude standard organ donation work-up times.
All authors contributed to the concept and outline of the article. RLD and MM extracted and analysed the data. RLD wrote the draft and all authors contributed to the revision and finalisation of the manuscript.
Funding/Source of Funding
No external funding was received.
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