CPR and organ donation

Michael Parr, Liverpool and MUH ICU, UNSW, MUVanessa Palmer DSN, SWSLHD

COI• Director Liverpool and MUH ICUs• Deputy Chair ARC• ILCOR ALS Task Force• Editor for Resuscitation

• Registered organ donor

Organ donation• More than 7 individuals waiting for organ

donation can be helped by a single donor

• Cardiac arrest victims that do not survive can become organ donors

• Prior to 1968 all organ donors were donation after circulatory death (DCD)

• Establishment of criteria for brain death in 1968 allowed donation after “neurological determination of death” (DBD)

• DBD became the leading source of organs due to improved graft quality and the potential of multiple organs per donor

“My brain is dead but they have the rest of my body on a life-support machine”

LegislationDonation of organs and tissues after death is governed by laws.

• In 1977, the Australian Law Reform Commission addressed the absence of a definition of death in Australian law, recommending that a statutory definition of death should be introduced. Recommending death be defined as:

a) irreversible cessation of all function of the brain of the person; or b) irreversible cessation of circulation of blood in the body of the person.

Legal definition in NSW• A person is dead when there is irreversible

cessation of the circulation of blood in the body of a person, or irreversible cessation of all function of the brain of the person.

Cause

Preconditions

Tests

BRAIN DEATH• .. “irreversible coma and irreversible loss

of brain stem reflex responses and respiratory center function or by the demonstration of the cessation of intracranial flow.”

Sandroni C et al. The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-

analysis. Intensive Care Med. 2016;42:1661–1671

CONCLUSIONS:• In patients with hypoxic-ischaemic brain injury

following CPR, >10 % of brain dead • > 40 % of brain-dead patients could donate

organs.

• Shortage of donated organs and improvement in critical care is increasing DCD numbers

Category Sub-category Definition Detailed Definition

Category I

Uncontrolled

Ia – Out-of-HospitalFound dead Sudden unexpected CA without resuscitation by a medical team

Ib – In-Hospital

Category II

Uncontrolled

IIa – Out-of-HospitalWitnessed cardiac arrest

Sudden, unexpected irreversible CA with unsuccessful resuscitation by a medical teamIIb – In-Hospital

Category III

ControlledWithdrawal of life sustaining therapy Planned withdrawal of life sustaining therapy

Category IV

Uncontrolled / Controlled

Sudden CA after brain death diagnosis

Sudden CA after brain death diagnosis during donor management but prior to donation

MODIFIED MAASTRICHT CLASSIFICATION -PARIS 2013

Category V

DCD• Universal systematic approach developed by

multi-region working group supported by The Transplantation Society, the OrganizaciónNacional de Trasplantes, and the World Health Organization (WHO).

Thuong 2016

Australian and New Zealand Intensive Care Society

Thuong 2016

Thuong 2016

ECMO

Hill and Bramson, California 1971

Extracorporeal CPR (eCPR)

Australia’s potential deceased organ donor population and transplant outcomes

Deceased organ donors by donation pathway

Deceased organ donors and transplant recipients 2000-2018

Deceased organ transplant procedures

Deceased organ donation and transplant rates

Deceased organ donation rates by jurisdiction

Deceased organ donation rates by jurisdiction

National consent rate

State and territory consent rates

Registration and family discussion make a difference

State and territory registration rates

CPR and organ donationCOIOrgan donationSlide Number 4Slide Number 5LegislationLegal definition in NSWSlide Number 8BRAIN DEATHSandroni C et al. The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis. Intensive Care Med. 2016;42:1661–1671Slide Number 11MODIFIED MAASTRICHT CLASSIFICATION -PARIS 2013DCDSlide Number 14Australian and New Zealand Intensive Care SocietySlide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22ECMOExtracorporeal CPR (eCPR) Slide Number 25Slide Number 26Slide Number 27 Slide Number 29 Slide Number 33 Slide Number 35 Slide Number 37Slide Number 38