Tissue and Organ Procurement Clinical Trial
Official title:
DCD III Study: a Multicentre Prospective Study to Identify Parameters Predicting Time to Death in Controlled Circulatory Death (cDCD) Donors and Prospective Validation of Previous Derived Prediction Models on Time to Death.
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.
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.
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