Prehospital emergency medicine and non-heart-beating donors: is there a future together?

Objectives
One of the major questions for transplant coordination teams in Portugal is how to expand the donors' pool, in order to satisfy the population needs. The use of non-heart-beating donors (NHBD) could help to deal with this problem of organ shortage. In addition to difficulties with legal and ethical acceptability, there are concerns regarding medical safety, which prevent the widespread use of these donors [1].

Methods
Lisbon has an emergency medical service with a response time under 10 min and all four Prehospital Emergency Medical Teams (VMER) are able to perform all kinds of advanced life support manoeuvres in situ and during transport to hospital. We perform a retrospective study of all cardiopulmonary arrest emergency calls (112 calls) assisted by our VMER, at Hospital S Francisco Xavier, during 2003. Then, we analyse how many of these cases could have 'matched' a protocol for uncontrolled NHBD [2]; that is, patients who die outside of hospital and are transported to hospital for organ donation.

Results
In 2003, our VMER assisted 2266 emergency calls; 13.8% (312) were cardiopulmonary arrest (CPA) cases and advanced cardiac life support was always performed. All major trauma and drowning events, as well as patients older than 55 years of age, were excluded (total of 217) from this study. Only 16.9% (16) of the remaining CPA (95) were resuscitated (less than our global average rate of 27%) and transported to the hospital with return of spontaneous circulation. A total of 79 cases resulted in patients who died outside of hospital and could have been transported to the hospital for organ donation if there were a protocol for NHBD in Portugal.

Conclusions
An average rate of 25% of all CPA events assisted by our VMER could have resulted in NHBD A specific protocol must be developed in the near future because non-heart beating programmes are a good option to increase the donors' pool. Current data suggest that organs and tissues obtained are of the same or better quality than those obtained from encephalic death donors [3].

References
1. Arias-Diaz J: Non-heart-beating donation: current state of the art.
Transplant Proc 2004, 36:1891-1893.
2. Protocol of NHBD. Madrid: Transplantation Care Unit, Hospital Clinic San Carlos.
3. Rio Gallegos F: Non heart beating donors. Successfully expanding the donor's pool. Ann. Transplant 2004, 9:19-20.

Source:
Critical Care 2005, N°9 (Suppl. 1): Page 250
Article by:
A. Lufinha 1, 2 and C. Ferreira 2, 3
1 Hospital Militar Principal, Lisbon, Portugal
2 Hospital São Francisco Xavier SA, Lisbon, Portugal
3 Hospital Curry Cabral, Lisbon, Portugal,
from 25th International Symposium on Intensive Care and Emergency Medicine
Brussels, Belgium, 21–25 March 2005.