According to the Canadian Institute for Health Information (CIHI), 3,404 Canadians were on a waiting list to receive an organ for transplant in 2012. Kidneys represented nearly two thirds of the organs needed for transplantation in this country. In 2012 alone, there were 2,450 patients (active and on hold) on the waiting list for a kidney. Fifty-nine of these patients died while waiting for a transplant.
Traditionally, organs for donation have come from either from living donors or donors who experienced brain death. These organs can be procured from the donor while the heart is still beating and blood is flowing through the body. The number of organs available from these donors has never been sufficient to provide for all of the patients on the waiting lists for transplant. More recently, donation after cardiocirculatory death (DCD) has been investigated as a method to increase the number of organs available for donation. A report covering the first 25 years of transplantation in Maastrict, Netherlands showed a 44% increase in overall organ donation when DCD was allowed. In 2012, 1,025 total adult kidney transplants were performed in Canada. Of these, only 111 kidneys were DCD and 504 donation after brain death (DBD). Of 1533 retrieved organs, 183 were from DCD donors. The practice of DCD began in Canada in 2006 and the number of donors has increased from four in the first year to 71 in 2012.
In Canada and the US, controlled DCD is most commonly used method. Controlled cardiac death occurs in-hospital after it has been decided that life-sustaining therapy should be withdrawn and resuscitation not performed. The medical staff waits until after two to five minutes of demonstrated mechanical asystole before declaring death and procuring organs for transplant. In contrast, uncontrolled DCD includes donation from patients who have died outside of the hospital, were unsuccessfully resuscitated, or critically ill patients who experienced unexpected cardiac arrest in the hospital.
Policy makers require information on the relative benefits and risks associated with the donation of kidneys following cardiocirculatory death in order to support clinical practice decisions. The objective of this review is to evaluate the clinical evidence regarding the outcomes of patients who receive kidneys via DCD and the guidelines for the retrieval of kidneys from patients who experience cardiocirculatory death.
Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.
