Expanding the Donor Pool Through Intensive Care to Facilitate Organ Donation: Results of A Spanish Multicenter Study.

Background: Intensive Care to facilitate Organ Donation (ICOD) may help to increase the donor pool. We describe the Spanish experience with ICOD. Methods: ACCORD-Spain consisted of an audit of the donation pathway from patients dead as a result of a devastating brain injury (possible donors) in 68 hospitals during 11/1/2014-4/30/2015. We focused on possible donors whose family was interviewed to discuss organ donation once intensive care with a therapeutic purpose was deemed futile and brain death (BD) was a likely outcome. Results: Of the 1970 possible donors in ACCORD-Spain, in 257 the family was interviewed once the decision had been made not to intubate/ventilate (n=105), with the patient under intubation/ventilation outside of the ICU (n=59), or with the patient intubated/ventilated within the ICU (n=93). Consent to ICOD was obtained in 174 cases. Consent was higher when the donor coordinator participated in the interview [OR 2.32; 95%CI 1.33-4.11; p=0.003]. 131 patients developed BD, of whom 117 transitioned to actual donation after BD. Of the 35 patients who did not develop BD, 2 transitioned to actual donation after circulatory death. 16 patients subject to ICOD were finally medically unsuitable organ donors. ICOD contributed to 24% of the 491 actual donors registered in ACCORD-Spain. Conclusions: Despite the complexity of the interview, the majority of families consent to ICOD. Estimating the probability of BD and assessing medical suitability are additional challenges of the practice. ICOD represents a clear opportunity to increase the donor pool and ensures organ donation is posed at every end-of-life care pathway. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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