NIV Congres

Objective To evaluate organ donation after circulatory death (DCD) category 3 in the Netherlands.

Methods Data on DCD3 organ donors in the Netherlands over the period 1998-Nov.2012 were analyzed per year; number reported to Eurotransplant, percentage used for transplantation and the age distribution. In medical record reviews of patients died in intensive care units during 2007-2011 we evaluated the reasons why organ procurement was not realized, after consent was given for DCD3 by the Donor Registry or the family.

Results The number of DCD3 donors from the Netherlands that were reported increased from 21 in 1998 to 163 in 2012, leading to an increase of DCD3 among reported deceased donors from 10% to 56%. Meanwhile the number of reported donation after brain death (DBD) donors fluctuated between 111 and 170 (mean 138 per year) and the number of other DCD category (1, 2 or 4) donors fluctuated between 6 and 24 (mean 12 per year). The percentage of reported deceased donors that were actually used for transplantation decreased from 94% in 1998 to 79% in 2012 and was mainly caused by a lower use of reported DCD3, and use in DCD3 even decreased from 90% to 67% in these 15 years. During these years the DCD3 group got older and the percentage of used donors decrease considerably with age in this group. Main reason for non procurement was, that potential DCD donors did not die within the time limit of 2 hours after withdrawal of treatment. The percentage of multi-organ donors among used DCD3 increased from 0% in 1998 to 48% in 2012.

Conclusions Introduction of DCD3 in the Netherlands resulted in a higher rate of donation activities, but a lower increase of used donors and transplants. It is caused by the 2 hours time limit rule for DCD3 and the relatively low percentage of used organs from an increasing number of older DCD3 donors.