Paris Cité University, Paris Research Cardiovascular Center (PARCC), INSERM, F-75015 Paris, France; Emergency Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, F-75015 Paris, France.
Paris Cité University, Paris Research Cardiovascular Center (PARCC), INSERM, F-75015 Paris, France; Emergency Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Georges Pompidou European Hospital, F-75015 Paris, France.
Resuscitation. 2024 Aug;201:110318. doi: 10.1016/j.resuscitation.2024.110318. Epub 2024 Jul 14.
Uncontrolled donation after circulatory determination of death (uDCD) has been developed and can serve as a source of kidneys for transplantation, especially when considering patients that meet extended criteria donation (ECD).
This study assessed the theorical size and characteristics of the potential pool of kidney transplants from uDCD with standard criteria donation (SCD) and ECD among patients who meet Termination of Resuscitation (TOR) criteria following Out of Hospital Cardiac Arrest (OHCA).
This study focused on adult patients experiencing unexpected OHCA, who were prospectively enrolled in the Parisian registry from May 16th, 2011, to December 31st, 2020.
During the study period, EMS attempted resuscitation for 19,976 OHCA patients, of which 64.5% (12,890) had no return of spontaneous circulation. Among them, 47.4% (9,461) had TOR criteria, representing no chance of survival, and from them, 8.8% (1,764) met SCD criteria and could be potential organ donors and 33.6% (6,720) met ECD for kidney donors. The mean potential number per year of uDCD candidates with SCD and ECD remain stable respectively around 98 (±10.8) and 672 (±103.8) cases per year. Elderly patients (≥65 y.o.) represented 61.2% (n = 5,763/9,461) of patients who met TOR and 100% (5763/5763) of patients who could have matched both ECD criteria and TOR.
Implementing uDCD program including SCD and ECD for kidney transplantation among OHCA cases quickly identified by the TOR, holds significant potential to substantially broaden the pool of organ donors. These programs could offer a viable solution to address the pressing burden of kidney shortage, particularly benefiting elderly recipients who may otherwise face prolonged waiting times and limited access to suitable organs.
循环死亡判定后的非控制捐献（uDCD）已被开发出来，可作为移植用肾脏的来源，尤其是在考虑符合扩展标准捐献（ECD）的患者时。
本研究评估了在符合复苏终止（TOR）标准的院外心脏骤停（OHCA）患者中，uDCD 与标准标准捐献（SCD）和 ECD 相结合，从潜在的肾脏捐献者中获得肾脏的理论规模和特征。
本研究集中于经历意外 OHCA 的成年患者，这些患者于 2011 年 5 月 16 日至 2020 年 12 月 31 日前瞻性地纳入巴黎登记处。
在研究期间，EMS 对 19976 名 OHCA 患者进行了复苏尝试，其中 64.5%（12890 名）无自主循环恢复。其中，47.4%（9461 名）有 TOR 标准，代表没有生存机会，其中 8.8%（1764 名）符合 SCD 标准，可能成为器官捐献者，33.6%（6720 名）符合 ECD 标准，可作为肾脏捐献者。每年符合 SCD 和 ECD 的 uDCD 候选者的潜在人数平均值分别稳定在每年 98（±10.8）和 672（±103.8）例左右。老年患者（≥65 岁）占符合 TOR 的患者的 61.2%（n=5763/9461）和符合 ECD 标准和 TOR 的患者的 100%（5763/5763）。
在 OHCA 患者中实施包括 SCD 和 ECD 的 uDCD 项目，以快速确定 TOR，这具有显著扩大器官捐献者群体的潜力。这些项目可能为解决紧迫的肾脏短缺问题提供可行的解决方案，特别是使老年受者受益，他们否则可能面临更长的等待时间和有限的获得合适器官的机会。
