Top Things to Know: Organ Donation after Out-of-Hospital Cardiac Arrest

Published: August 08, 2023

Prepared by The Organ Donation Writing Group; Laurie J. Morrison, MD, MSc, FRCPC

  1. Saving lives through organ donation remains variable around the world due to shortages on viable organs. This statement aims to guide the process post sudden cardiac death to improve the organ transplant opportunities to improve and prolong the lives of those who are organ recipients.
  2. When resuscitation for cardiac arrest fails, organ donation should be considered.
  3. Uncontrolled Donation after Circulatory Death (uDCD) is a potential source of organ donors in the out-of-hospital cardiac arrest population, but significant operational, ethical and legal barriers exist across most jurisdictions.
  4. Legislative changes to a default consent or an opt out approach for all adults will increase donor availability and transplant rates and the increase in volume will contribute to improved transplantation infrastructure and cost-effective ratios.
  5. There are little data related to organ donation after cardiac arrest and this statement has provided recommendations to address this.
  6. Current DCD categories in the modified Maastricht classification limit comparisons based on the type of donor for unwitnessed and witnessed out-of-hospital and in-hospital cardiac arrest. We propose changes to allow consistent and uniform data collection across all nations.
  7. Clinical registries, clinical trials and quality indices in cardiac arrest and trauma should collect organ donation variables as clinically relevant outcomes. We recommend revision of the Utstein template include organ donation variables as mandatory elements to enable uniform reporting.
  8. Algorithms and guidelines for the management of cardiac arrest should consider organ donation as a routine component of post cardiac arrest care and a measurable outcome in future research and performance metrics for health care systems.
  9. The published validated termination of resuscitation (TOR) rule should be more uniformly implemented to support decisions around termination of resuscitation and transition to organ preservation in systems where uDCD is feasible. Additional TOR rules to support decisions around termination of resuscitation and transition to organ preservation need to be derived and validated in a number of unique populations.
  10. The feasibility and acceptability of different implementation strategies for uDCD after out-of-hospital cardiac arrest should be explored through future implementation research directed to address and guide the operational, ethical, economic and clinical challenges identified to date.
  11. Communities that include extracorporeal cardiopulmonary resuscitation (eCPR) programs as resuscitation strategies to treat OHCA should consider incorporating plans for the systematic evaluation and identification of potential organ donors, such that if and when patients have expected or unexpected deaths, organ donation can occur.

View the summary for Organ Donation After Out-of-Hospital Cardiac Arrest

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Citation

Morrison LJ, Sandroni C, Grunau B, Parr M, Macneil F, Perkins GD, Aibiki M, Censullo E, Lin S, Neumar RW, Brooks SC; on behalf of the International Liaison Committee on Resuscitation. Organ donation after out-of-hospital cardiac arrest: a scientific statement from the International Liaison Committee on Resuscitation [published online ahead of print August 8, 2023]. Circulation. doi: 10.1161/CIR.0000000000001125

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