For Public or Lay Providers
The International Liaison Committee on Resuscitation Scientific Statement on Organ Donation After Out-of-Hospital Cardiac Arrest: Scope of Work Proposal for Public Comments
The International Liaison Committee on Resuscitation (ILCOR) has commissioned a scientific statement pertaining to organ donation after out-of-hospital cardiac arrest. The purpose of this post on ILCOR.org is to reach out to the broader community for comments on the scope of the review. Some of the sections below are very technical. This is a plain English version of the document, but still contains some highly technical sections. Resuscitation or transplant specialists in your country can explain them if you need help. However, we are happy for you to comment on the sections that interest you and not all sections.
It is unclear how many victims who die after initial resuscitation from out-of-hospital cardiac arrest have wishes consistent with, and are eligible to provide organs or tissues for donation. This is important because potentially 8 individuals waiting for transplantation can be helped by a single donor. If we can optimize the organ donation process for our communities we may see a dramatic improvement in survival and quality of life or wellness index within our communities. There are lots of barriers to helping physicians and families make decisions about organ donation after out-of-hospital cardiac arrest and this summary could contribute to helping to break down these barriers. There are countries (e.g. Spain and the Netherlands) that are achieving high rates of organ donation that may be using strategies that others can learn from. There are countries such as South Africa where organ donation after cardiac death has not been implemented and where the potential for transplant is lost.
Scope of work of the proposed scientific statement for public
There are two main categories of organ donors:
1. Donor after Circulatory death (DCD). This is where the heart will not function well enough to sustain life
2. Donor after Neurological Determination of Death (DNDD). This is what is commonly called “brain death.” There are strict regulations in all countries using this classification. This means that it is not practicable to use this category when the heart stops beating unexpectedly.
The circulatory death category includes sub-categories IA, IIA, III, IV according to the circumstances when the heart stops beating
- Category I- Uncontrolled (further subcategory IA when out of hospital) CA (cardiac arrest, ie the heart stops beating)- Found Dead, not witnessed
- Category II – Uncontrolled (further subcategory IIA when out of hospital) CA - Witnessed Cardiac arrest
- Category III - Controlled - Withdrawal of Life Sustaining Therapy
- Category IV – “Uncontrolled controlled” - Heart stops unexpectedly during or after the process of brain death determination and prior to organ donation
Look at how OHCA patients who do not survive can become organ donors after circulatory death (DCD) or after Neurological Determination of Death (DNDD) and look at the numbers in the categories above.
2.1 We will find what the published scientific literature tells us about how common and what outcomes are seen in these categories of donation after out-of-hospital cardiac arrest (heart stops unexpectedly). Report for both categories namely:
- Circulatory Death (DCD), both controlled and uncontrolled
- Brain Death (DNDD)
2.2 Estimate the number of potential donors after out of hospital cardiac arrest as well as unexpected cardiac arrest during determination of brain death based on published registry data.
3.0 Strategies to close the gap between incidence of donation and potential donation
3.1 Strategies published in the literature which are associated with increased rates of organ donation among patients after out of hospital cardiac arrest
3.2 Strategies published in the literature associated with improved organ function and organ transplantation success rates after out of hospital cardiac arrest (ie techniques used before donation to improve organ survival)
3.3 Special Case Extracorporeal CPR (ECPR) (a more invasive technique which provides an external device to pump blood, sometimes through an artificial lung)
- 3.3.1 Published decision rules to guide end-of-life care in patients treated with ECPR after out of hospital cardiac arrest so that potential organ donors can be identified
- 3.3.2 Published guidelines for when to terminate ECPR and consider organ donation
- 3.3.3 Identify where we don’t have rules
3.4 Criteria (When) for transitioning from active resuscitation to organ preservation (techniques to improve the function of organs after donation) in patients with out of hospital cardiac arrest. Look for guidelines and decision rules that address this
3.5 Process (How) for transitioning from active resuscitation to organ preservation(techniques to improve the function of organs after donation) in patients with out of hospital cardiac arrest - look for implementation strategies
4.0 Ethical considerations for organ donation after out-of-hospital cardiac arrest
4.1 What ethical concerns do you think need to be addressed for organ donation from person with unsuccessful resuscitation of out of hospital cardiac arrest
4.2 What do you think most concerns families of potential organ donor from person with unsuccessful resuscitation of out of hospital cardiac arrest
4.3 Do you think there is a problem deciding when to change from trying to resuscitate a person to preserving their organs for transplantation?
5.0 Cost effectiveness of donation after out-of-hospital cardiac arrest
5.1 Organ donation after the initial resuscitation succeeds but the patient does not survive, but no special techniques of resuscitation have been used
5.2 Organ donation after the initial resuscitation succeeds, but the patient does not survive when special techniques of resuscitation have been used
5.3 Unexpected cessation of heart beat when the initial resuscitation fails and the heart does not restart, however the resuscitation was done
A narrative review and consensus across international experts from multiple disciplines, that will summarize key published data on important issues related to organ donation after OHCA. The review will provide guidance and support the development of treatment recommendations and identify strategies to optimize rates of ethical organ procurement and successful organ transplantation after out-of-hospital cardiac arrest. We will identify knowledge gaps and priorities for research.
To ensure the review includes the patient, family and community perspective we will use www.ilcor.org to iteratively engage relevant sectors of the global public to provide input and shape the final product. We thank you for taking the time to review and comment on this scope of work proposal.
The approved writing group consists of scientists representing allied health professionals and physicians from across the world. The authors have been reviewed and approved based on the conflict of interest policy.