• Leonie H Venema, Aukje Brat, Danielle M Nijkamp, Christina Krikke, Leuvenink Henri G D HGD Department of Surgery, University of Groningen, University Medical Center Groningen, The Netherlands., Wim C de Jongh, Tjarda N Tromp, J Adam Van der Vliet, Bens Bas W J BWJ Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, The Netherlands., and Michiel E Erasmus.
• Department of Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.
• Transplantation. 2019 Sep 1; 103 (9): e256-e262.

BackgroundOrgan shortage remains a problem in transplantation. An expansion of the donor pool could be the introduction of unexpected donation after circulatory death (uDCD) donors. The goal of this study was to increase the number of transplantable kidneys and lungs by implementing a uDCD protocol.MethodsA comprehensive protocol for uDCD donation was developed and implemented in the emergency departments (EDs) of 3 transplant centers. All out-of-hospital cardiac arrest (OHCA) patients were screened for uDCD donation. Inclusion criteria were declaration of death in the ED, age (<50 y for kidneys, <65 y for lungs), witnessed arrest, and basic and advanced life support started within 10 and 20 min, respectively.ResultsA total of 553 OHCA patients were reported during the project, of which 248 patients survived (44.8%). A total of 87 potential lung and 42 potential kidneys donors were identified. A broad spectrum of reasons resulted in termination of all uDCD procedures. Inclusion and organ-specific exclusion criteria were the most common reason for not proceeding followed by consent. None of the potential donors could be converted into an actual donor.ConclusionAlthough uDCD potential was shown by successful recognition of potential donors in the ED, we were not able to transplant any organs during the study period. The Dutch Emergency medical service guidelines to stop futile OHCA in the prehospital setting and the strict use of inclusion and exclusion criteria like age and witnessed arrest hampered the utilization. A prehospital uDCD protocol to bring all OHCA patients who are potential uDCD candidates to an ED would be helpful in creating a successful uDCD program.

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