DeVita Michael A, Callaway Clifton W, Pacella Charissa, Brooks Maria Mori, Lutz John, Stuart Susan
Harlem Hospital Center, New York, NY, USA
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Prog Transplant. 2016 Mar;26(1):21-7. doi: 10.1177/1526924816632117.
In the United States, organ donation after circulatory death (DCD) determination is increasing among those who are removed from life-sustaining therapy but is rare when death is unexpected. We created a program for uncontrolled DCD (uDCD).
A comprehensive program was created to train personnel to identify and respond quickly to potential donors after unexpected death. The process termed Condition T was implemented in the emergency department (ED) of 2 academic medical centers. All ED deaths were screened for uDCD potential. Eligible donors included patients with preexisting donor designation who received cardiopulmonary resuscitation, failed to respond, and were pronounced dead.
Over 350 nurses, physicians, perfusionists, organ procurement personnel, and administrators were trained. From February 2009 to June 2010, a total of 18 patients were potential Condition T candidates. Six Condition T responses were triggered. Three donors underwent cannulation, and 4 organs were recovered (3 kidney and 1 liver) from 2 donors. Time from Condition T trigger to perfusion with organ preservation solution ranged from 14 to 22.3 minutes. Perfusion duration was 197 and 221 minutes. No recovered organs were transplanted because biopsies showed prolonged warm ischemia.
It is feasible to create a process to rapidly intervene in the ED for uDCD. However, no organ transplants resulted. The utility and sustainability of an uDCD program in this particular setting are questionable.
在美国，循环性死亡（DCD）判定后的器官捐献在那些撤除生命维持治疗的人群中呈上升趋势，但在意外死亡时却很罕见。我们创建了一个非控制性DCD（uDCD）项目。
创建了一个综合项目来培训人员，以便在意外死亡后识别潜在捐献者并迅速做出反应。名为“T状态”的流程在2家学术医疗中心的急诊科实施。对所有急诊科死亡病例进行uDCD可能性筛查。符合条件的捐献者包括预先指定为捐献者且接受了心肺复苏、无反应并被宣告死亡的患者。
超过350名护士、医生、灌注师、器官获取人员和管理人员接受了培训。从2009年2月至201年6月，共有18例患者为潜在的“T状态”候选者。触发了6次“T状态”反应。3名捐献者接受了插管，从2名捐献者身上获取了4个器官（3个肾脏和1个肝脏）。从“T状态”触发到用器官保存液灌注的时间为14至22.3分钟。灌注持续时间为197分钟和221分钟。由于活检显示存在长时间的热缺血，获取的器官均未进行移植。
创建一个在急诊科对uDCD进行快速干预的流程是可行的。然而，没有进行器官移植。在这种特定情况下，uDCD项目的实用性和可持续性值得怀疑。
