Cardiac Output Monitoring in Donation After Cardiac Death

Principal Investigator – Angela Summers

Donation after cardiac death (DCD donors) occurs when a donors condition is deemed irrecoverable, but the donor does not satisfy the criteria required for brain-stem death. Therefore, treatment is withdrawn, with the expectation of the patients’ heart stopping and the organs retrieved following cardiac arrest. However, this time period is unknown, and currently approximately 50% of DCD donors do not proceed to donation because the donor fails to die within a set time period. Furthermore, there are anxieties about using organs from these donors, as historically, outcomes of transplants utilising these organs have been inferior to outcomes from donors after brainstem death. Therefore, current criteria outlining how long we wait from withdrawal of treatment to cardiac arrest are arbitrary and likely conservative. We believe there is therefore scope to improve the assessment of a DCD donor and whether the organs are likely to be suitable to transplant.

Currently, the patients’ pulse, blood pressure and oxygen blood saturations are used to judge whether the organs are likely to be suitable for transplant. However, a cardiac output monitor would inform us, in more detail about how well the donors’ organs are functioning and how much oxygen is being delivered to the tissues. Potentially, it provides a more objective method of assessing a donors’ physiology prior to donation.

This study therefore aims to assess our current criteria for DCD donation, correlate these criteria to the cardiac output monitor and correlate these readings to organ outcome. Ultimately, we want to establish new criteria for use as guidance in the DCD donation process, based upon physiological parameters.