Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

M Renaudier; Y Binois; F Dumas; L Lamhaut; F Beganton; D Jost; J Charpentier; O Lesieur; E Marijon; X Jouven; A Cariou; W Bougouin; Paris Sudden Death Expertise Center group

doi:10.1186/s13613-022-01023-7

Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

Ann Intensive Care. 2022 Jun 6;12(1):48. doi: 10.1186/s13613-022-01023-7.

Authors

M Renaudier^{1

2}, Y Binois^{1

2}, F Dumas^{1

2

3

4}, L Lamhaut^{1

2

4

5}, F Beganton^{1

2}, D Jost^{1

2

6}, J Charpentier⁷, O Lesieur^{4

8}, E Marijon^{1

2

4

9}, X Jouven^{1

2

4

9}, A Cariou^{10

11

12

13}, W Bougouin^{1

2

14}; Paris Sudden Death Expertise Center group

Collaborators

Paris Sudden Death Expertise Center group:
F Adnet, J M Agostinucci, N Aissaoui-Balanant, V Algalarrondo, F Alla, C Alonso, W Amara, D Annane, C Antoine, P Aubry, E Azoulay, F Beganton, C Billon, W Bougouin, J Boutet, C Bruel, P Bruneval, A Cariou, P Carli, E Casalino, C Cerf, A Chaib, B Cholley, Y Cohen, A Combes, J M Coulaud, M Crahes, D Da Silva, V Das, A Demoule, I Denjoy, N Deye, J L Diehl, S Dinanian, L Domanski, D Dreyfuss, D Duboc, J L Dubois-Rande, F Dumas, J Duranteau, J P Empana, F Extramiana, J Y Fagon, M Fartoukh, F Fieux, M Gabbas, E Gandjbakhch, G Geri, B Guidet, F Halimi, P Henry, F Hidden Lucet, P Jabre, L Joseph, D Jost, X Jouven, N Karam, H Kassim, J Lacotte, K Lahlou-Laforet, L Lamhaut, A Lanceleur, O Langeron, T Lavergne, E Lecarpentier, A Leenhardt, N Lellouche, V Lemiale, F Lemoine, F Linval, T Loeb, B Ludes, C E Luyt, A Maltret, N Mansencal, N Mansouri, E Marijon, J Marty, E Maury, V Maxime, B Megarbane, A Mekontso-Dessap, H Mentec, J P Mira, X Monnet, K Narayanan, N Ngoyi, M C Perier, O Piot, R Pirracchio, P Plaisance, B Plaud, I Plu, J H Raphalen, M Raux, F Revaux, J D Ricard, C Richard, B Riou, F Roussin, F Santoli, F Schortgen, A Sharifzadehgan, T Sharshar, G Sideris, T Similowski, C Spaulding, J L Teboul, J F Timsit, J P Tourtier, P Tuppin, C Ursat, O Varenne, A Vieillard-Baron, S Voicu, K Wahbi, V Waldmann

Affiliations

¹ Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.
² Paris Sudden Death Expertise Center, Paris, France.
³ Emergency Department, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France.
⁴ Université de Paris, Paris, France.
⁵ Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France.
⁶ Brigade Des Sapeurs-Pompiers de Paris (BSPP), Paris, France.
⁷ Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris Cedex 14, France.
⁸ Intensive Care Unit, Saint Louis General Hospital, La Rochelle, France.
⁹ Cardiology Department, European Georges Pompidou Hospital, AP-HP, Paris, France.
¹⁰ Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France. alain.cariou@cch.aphp.fr.
¹¹ Paris Sudden Death Expertise Center, Paris, France. alain.cariou@cch.aphp.fr.
¹² Université de Paris, Paris, France. alain.cariou@cch.aphp.fr.
¹³ Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris Cedex 14, France. alain.cariou@cch.aphp.fr.
¹⁴ Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France.

Abstract

Background: Organ shortage is a major public health issue, and patients who die after out-of-hospital cardiac arrest (OHCA) could be a valuable source of organs. Here, our objective was to identify factors associated with organ donation after brain death complicating OHCA, in unselected patients entered into a comprehensive real-life registry covering a well-defined geographic area.

Methods: We prospectively analyzed consecutive adults with OHCA who were successfully resuscitated, but died in intensive care units in the Paris region in 2011-2018. The primary outcome was organ donation after brain death. Independent risk factors were identified using logistic regression analysis. One-year graft survival was assessed using Cox and log-rank tests.

Results: Of the 3061 included patients, 136 (4.4%) became organ donors after brain death, i.e., 28% of the patients with brain death. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, factors associated with organ donation were neurological cause of OHCA (odds ratio [OR], 14.5 [7.6-27.4], P < 0.001), higher pH (OR/0.1 increase, 1.3 [1.1-1.6], P < 0.001); older age was negatively associated with donation (OR/10-year increase, 0.7 [0.6-0.8], P < 0.001). In patients without post-resuscitation shock, the factor associated with donation was neurological cause of OHCA (OR, 6.9 [3.0-15.9], P < 0.001); higher pH (OR/0.1 increase, 0.8 [0.7-1.0], P = 0.04) and OHCA at home (OR, 0.4 [0.2-0.7], P = 0.006) were negatively associated with organ donation. One-year graft survival did not differ according to Utstein characteristics of the donor.

Conclusions: 4% of patients who died in ICU after OHCA led to organ donation. Patients with OHCA constitute a valuable source of donated organs, and special attention should be paid to young patients with OHCA of neurological cause.

Keywords: Brain death; Epidemiology; Organ donation; Out-of-hospital cardiac arrest.