Kidney transplant function using organs from non-heart-beating donorsmaintained by mechanical chest compressions
, Luis Pardillos-Ferrer
, José María Navalpotro-Pascual
, María Eugenia Martin-Maldonado
, Amado Andrés-Belmonte
Servicio de Urgencias Médicas de Madrid SUMMA112, Spain
Coordinación de trasplantes, Hospital Universitario 12 de Octubre, Madrid, Spain
a r t i c l e i n f o
Received 10 February 2010Received in revised form 12 April 2010Accepted 28 April 2010
Non-heart beating donorsEmergency medical servicesTransplantation
a b s t r a c t
Thisstudyaimstodeterminethefailurerateoftransplantedkidneygraftsinrecipientsoforgansfrom non-heart beating donors (NHBDs) who have had mechanical chest compressions to maintain acirculation before organ retrieval.
Aretrospectiveobservationalstudybasedonreviewoftheemergencymedicalservicedatabaseand case histories of NHBDs, and information periodically sent by transplant units about donors andorgans. The following variables were studied: age, sex, transfer hospital, time to arrival on the scene of cardiopulmonaryarrest,timetoarrivalinhospital,numberandtypeoforgansretrieved,useofmechan-ical chest compression devices, and kidney function in graft recipients. The study covered the periodbetween January 2008 and November 2009. During 2008 standard manual chest compressions wereused and during 2009 mechanical chest compression devices were used.
In39transplantedkidneysfromdonorsreceivingmechanicalchestcompressionsprimaryfailurewasdocumentedinrecipientsontwooccasions(5.1%).Kidneystransplantedfromdonorswhohadman-ual chest compressions resulted in three primary failures in recipients (9.1%). The difference betweenthe two groups was not signiﬁcant (
=0.5). Three patients achieved successful return of spontaneouscirculation in the mechanical chest compression group after initiation of the NHBD donor protocol.
Wehavedescribedourexperienceandprotocolfornon-heartbeatingdonationusingvictimsofout-of-hospitalcardiacarrestinwhomcardiopulmonaryresuscitationhasbeenunsuccessfulasdonors.Primary kidney graft failure rates in organs from non-heart beating donors is similar when manual ormechanical chest compression devices are used during cardiopulmonary resuscitation.© 2010 Elsevier Ireland Ltd. All rights reserved.
Non-heart-beating donors (NHBDs) have to meet predeﬁnedcriteria for organ donation
including death from irreversible ces-sation of the beating heart. In 1995 the Maastricht conference
deﬁned four NHBD categories to differentiate their viability, andprovide ethical and legal support.
Type I donors (admitted to thecentre after death) and type II donors (resulting from unsuccessfulcardiopulmonary resuscitation (CPR) attempts) are referred to as
donors, since the precise duration of warm ischaemiais not known in these donors. In Spain, NHBDs who originate fromthe out-hospital setting correspond to type II donors. These are
Corresponding author at: C/ Antracita 2 bis, 28045 Madrid, Spain.Tel.: +34 607110309.
patients who have suffered a cardiac arrest outside hospital, andafter failed CPR attempts are then transferred with continued CPRto hospital for organ donation.MobileEmergencyUnitdoctorsarelegallyandethicallyenabledto diagnose (but not certify) the death of the patient and activatethe donor protocol. In Spain all individuals whose views on organdonation are not known are considered as organ donors.
In spiteof this family permission is also obtained. This is regulated by theRoyal Decree 2070/1999 relating to the donation and transplanta-tion of organs and tissues.
This allows the diagnosis of death aftercardiorespiratory arrest according to the following:
The unequivocal conﬁrmation of the absence of a heart beat,diagnosedbytheabsenceofacentralpulseorasystoleontheelec-trocardiogram,andtheabsenceofspontaneousbreathing—beingobserved for a period of at least 5min.
The irreversibility of the cessation of cardiorespiratory functionmustbeconﬁrmedafteranadequateperiodofadvancedCPR.Thisperiod,andCPRinterventionsshouldbeappropriatefortheageof