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Master Thesis

Controlled donation after Circulatory Death (category Maastricht 3) : first outcomes in a pilot centre

Abstract : INTRO: In France, controlled Donation after Circulatory Death (cDCD) following a Withdrawal of Life Sustaining Treatment (WLST) allows a new way of organ donation since authorisation was given by the Agence de la Biomédecine in December 2014. We describe our first 13 months of experience of this new national program in a pilot centre. METHODS: Between 1/12/2014 to 31/12/2015 prospective observational study included each potential patients with irreversible neurological injuries undergoing a WLST procedure hospitalised in our ICU. The WLST procedure consistent with the recommendations of Intensive Care Societies. The characteristics from potential cDCD donors were analysed as well as each steps of the protocol. RESULTS: During the study, 952 patients have been admitted in ICU. The mortality rate was 20,6% [196/952] with a formalised Withholding or Whithdrawal (WhWd) procedure performed on 58% of patients [115/196]. A WhWd procedure concerned 59,6% circulatory deaths [99/166]. There were 33 Wh measures and 66 WLST. Seventeen patients were under 60 years of age, with 10 having irreversible brain injuries. Of this only 8 patients (0,8% of admission) were eligible to cDCD programme. The WLST procedure was extubation and titrated sedation systematically. The refusal rate was 37,5% : there were 1 family’s refusal and 2 patient’s whose refusals were attested by their relatives. A cannulation’s failure stopped the first procedure and 4 patients became utilised donors. The WLST decision underwent after 7 [7-10] days. The median agonal time was 20 [17-20] min. The normothermic Regional Perfusion (nRP) implementation was performed in ICU room after death declaration and then the donor was brought in theater room for procurement. This choice of preservation method permitted for relatives to stay longer with their kin. The median time of nRP was 193 [149-236] min. Finally, 8 kidneys and one liver could be retrieved and successfuly transplanted. There were no delayed graft function, no primary non-function, and the graft function a few months after transplantation were normalised for each recipients. The extension of age limit for donation to 65 would have to propose organ donation in 2 additional families. Psychological follow up was systematic and permitted good returns from relatives, without ethical issue regarding conflict of interest between the WLST decision and the donation project. On the same period, there were 30 brain deaths, and 22 became Donors after Brain Death (DBD). It represented 39 kidneys, 18 livers, 5 hearts and 4 lungs. The refusal rate for DBD was 10% [3/30]. Furthermore, 10 uDCD protocols were performed and 4 patients were retrieved; the refusal rate for uDCD was 40% (4/10). uDCD permittted 8 kidneys and 1 liver transplantations. CONCLUSION: Added to increase the pool organ with good functional grafts, cDCD allows for families to realise the wishes of a deceased relative who had previously expressed a wish to become a donor. These encouraging results were in line with the preliminary report of the ABM and allow to extend the procedure to new centres and patients up to the age of 65.
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Master Thesis
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Submitted on : Tuesday, July 26, 2016 - 2:22:12 PM
Last modification on : Wednesday, July 15, 2020 - 8:58:04 AM

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  • HAL Id : dumas-01348976, version 1

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Clémence Fauché. Controlled donation after Circulatory Death (category Maastricht 3) : first outcomes in a pilot centre. Human health and pathology. 2016. ⟨dumas-01348976⟩

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