Extended Criteria Donors (ECD) – Expanding the boundaries for Donation after Cardiac Death

NICOLA STITT^1,2, DAVID PILCHER^2,3,4, TIM CROZIER¹

¹INTENSIVE CARE UNIT, MONASH HEALTH, MELBOURNE, Australia, ²DONATELIFE VICTORIA, MELBOURNE, Australia, ³DEPT OF INTENSIVE CARE, THE ALFRED HOSPITAL, MELBOURNE, Australia, ⁴DEPARTMENT OF EPIDEMIOLOGY AND PREVENTATIVE MEDICINE, MONASH UNIVERSITY, MELBOURNE, Australia

Introduction

The upper age limit for lung donation via the Donation after Cardiac Death (DCD) pathway has generally been considered to be 65 years. We report a case of a 73 year old patient who was able to donate his lungs for transplantation.

Case Description

A 73 yr old male ex-smoker was admitted to the Intensive Care Unit (ICU) following an out-of-hospital cardiac arrest due to myocardial infarction.  The likelihood of neurological recovery was poor and during end of life discussions the family raised the possibility of organ donation with the Intensivist. As he was unlikely to progress to brain death the only option was the DCD pathway. However current guidelines suggested that he was over the age limit for lungs, liver and kidney donation, with the previous oldest DCD lung donor being 65 years old.

Upon consideration the Intensivist engaged the help of the Nurse Donation Specialist who investigated the possibility of donation with Donatelife Victoria (DLV). The initial response received was that he was too old for DCD. The family were disappointed with this outcome. Further discussions between the Intensivist and Organ Donor Coordinator (ODC) at DLV led to another approach to the lung transplant team for reconsideration.

Arterial Blood Gas (ABG) on 100% oxygen. pH 7.35, pCO2 42.3, pO2 458, BE -2. Chest X- ray & bronchoscopy were clear. Ventilation requirements were FiO2 = 0.30, PEEP 10cm, PS 12.*

After reviewing the patients’ current condition it was decided that he would be accepted as potential lung donor.

Following withdrawal of life sustaining therapy the patient died peacefully within the timeframe required for DCD. This resulted in successful lung donation, with subsequent successful bilateral lung transplantation

Conclusion

Exploring the possibility of extended criteria donation in carefully selected patients may result in more organs being available for transplant.

*PEEP: Positive End Expiratory Pressure   PS: Pressure Support