[Donation protocol following controlled cardiac death (Maastricht type III donation). First experience]

Abstract

Objective: To present our experience with the implementation of a donation protocol following controlled cardiac death (Maastricht type III donation).

Design: A retrospective descriptive and observational study was made.

Setting: Intensive Care Unit of a third-level university hospital.

Patients: Eight patients in an irreversible state, in which withdrawal of all life support had been agreed, were evaluated as potential donors.

Interventions: Application of the adopted protocol.

Variables of interest: Clinical data of donors, evaluation of a donation protocol following cardiac death, warm ischemia times, and short-term outcome of the recipients.

Results: Eight patients were evaluated. In one case donation was not possible because no cardiac arrest developed in the 120 minutes after extubation. The 7 remaining patients were effective kidney donors. Warm ischemia times were less than 23 minutes in all cases. Although 7 of the 14 recipients suffered delayed graft function, all of them achieved good renal function.

Conclusion: Donation after cardiac death in patients in an overwhelming and irreversible state represents a potential source of donors not previously considered in this country. The prior development of a consensus-based protocol can help increase the number of organs in combination with those obtained after brain death. In our experience, the results of kidney transplants obtained from donors after cardiac death are good, and the success of these types of protocols could be extended to other organs such as the liver and lungs.

Keywords: Donación de órganos tras la muerte cardiaca; Donantes tipo iii de Maastricht; Limitación de las técnicas de soporte vital; Limitation of life support techniques; Organ donations after cardiac death; Type iii Maastricht donors.