Cardiac arrest as an extended indication for organ donation

BACKGROUND: This study concerns the potential alleviation of the scarcity of donor organs in Germany by an extension of the indication for organ donation to cardiac arrest (donation after circulatory death, DCD). METHODS: Trends in the number of organ donations in nine European countries after the introduction of DCD were analyzed and projected onto the documented numbers of organ donations in Germany over the period 2011-2023 by means of regression analyses. The effect on liver and kidney transplantation in Germany was modeled for each scenario with the Eurotransplant simulators ELAS and ETKidney. RESULTS: Compared to the control scenario without DCD (829 liver transplantations), the largest increases in liver transplantation in 2023 were found with the scenarios for Spain (+384) and Switzerland (+290), followed by those for Belgium (+224), Italy (+155), the United Kingdom (+125), the Netherlands (+112), the Czech Republic (+87), and France (+69). Similarly, the largest increases in kidney transplantation compared to the control scenario without DCD (1361 kidney transplantations) were found in the scenarios for Spain (+1186), Switzerland (+850), the Netherlands (+699), the United Kingdom (+661), Italy (+551), Belgium (+455), the Czech Republic (+432), and France (+128). The Austrian scenario did not yield any increase in either liver or kidney transplantation (-10 and -44, respectively). In most of the scenarios, waiting lists, MELD scores, and the dialysis time at transplantation were reduced in parallel with the rise in the number of transplantations. CONCLUSION: These scenarios indicate that the introduction of a DCD program could help make more organs available. Its effect would nonetheless depend on accompanying structural measures and societal factors. DCD would probably not solve the problem of organ scarcity if instituted as a single measure.