Review articleAre patients brain-dead after successful resuscitation from cardiac arrest suitable as organ donors? A systematic review☆
Introduction
Brain death may occur in about one-sixth of patients after successfully resuscitated out-of-hospital cardiac arrest,1, 2 creating opportunities for organ donation. Unfortunately, ischemia-reperfusion injury may damage not only the brain but also other organs, making them potentially unsuitable for transplantation. Cardiac arrest is widely believed to decrease donor organ quality,3 however no scientific evidence is provided to support this belief.
We performed a systematic review to assess whether organs retrieved from donors brain dead after cardiac arrest have different outcome from organs retrieved from donors brain dead not due to cardiac arrest.
Section snippets
Methods
The review was conducted in accordance with the International Liaison Committee on Resuscitation (ILCOR) 2010 evidence evaluation process. Expert review of the search strategy and findings were conducted by the worksheet evaluation experts.
Study selection, quality assessment and characteristics of the included studies
The search in Cochrane Register of Controlled Trials and Cochrane Register of Systematic Reviews yielded no results. The search in MEDLINE and EMBASE yielded a total of 203 papers after duplicate removal. Of these, seven appeared relevant to the research question. Three of those seven studies7, 8, 9 were excluded because it was not clear whether cardiac arrest occurred before or after the diagnosis of brain death and the authors could not be contacted directly.
The characteristics of the four
Discussion
The main concern when considering patients resuscitated from CA as potential organ donors is the risk of donor organ damage due to ischemia-reperfusion injury. Ischemia following circulatory arrest causes depletion of intracellular adenosine triphosphate (ATP) stores, intracellular sodium and calcium accumulation and eventually cell death.13, 14 Cardiopulmonary resuscitation can restore organ perfusion, but once a critical period of ischemia is exceeded, it may also induce reperfusion injury
Limitations
The major limitation of the studies included in the present review is the relatively small size of the CA donor population. Another limitation is the retrospective design of two of the three included studies. Those two studies were based on retrospective chart review of recipients, not donors, so they are focused on the outcome of a single transplanted organ type and do not include data on the outcome of other possible organs harvested from multiple organ donors. For the same reason, those
Conclusion
Studies included in the present review showed that 1-year survival rates of kidneys, livers, hearts and intestines retrieved from donors brain death after cardiac arrest are not significantly different from that of organs transplanted from donors brain dead due to other causes. Patients brain dead after having been resuscitated from cardiac arrest can be considered as potential donors for organ transplantation.
Disclaimer
This review includes information on resuscitation questions developed through the C2010 Consensus on Science and Treatment Recommendations process, managed by the International Liaison Committee on Resuscitation (http://www.americanheart.org/ILCOR). The questions were developed by ILCOR Task Forces, using strict conflict of interest guidelines. In general, each question was assigned to two experts to complete a detailed structured review of the literature, and complete a detailed worksheet.
Conflict of interest statement
CS, FC, CM, TS, MA – none. CA and MM were authors of one of the studies included in final analysis. For this reason, they excluded themselves from both the eligibility and quality assessment process.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.08.037.