Enhancing Efficiency and Effectiveness of DCD: Implementation and Evaluation of Donation Advisor

The inability to effectively identify candidates for successful organ donation after circulatory determination of death (DCD) leads to wasted, costly and unsuccessful donation attempts. In addition, poor characterization of organ ischemia injury during DCD imperils effective recovery of organs and medical management of transplant recipients. We analyzed waveform data captured from 429 patients enrolled in the Death Prediction and Physiology After Removal of Therapy study to develop a prediction tool that can accurately predict rapidity of death and likelihood of DCD success of potential donors, as well as objectively assess degree of ischemic organ injury incurred during DCD. Combining these novel technologies, we created a novel clinical decision support tool called Donation Advisor (DA) in order to improve DCD efficiency and effectiveness and the experience of families of DCD eligible patients. We are currently actively enrolling patients in a multicenter observational study of DA in Ontario to assess the feasibility of implementing this novel tool at the bedside. Next, our work will focus on a feasibility RCT of DA in Canada, to inform the design of a future, large-scale randomized controlled trial that is expected to support the real-time decision-making around DCD candidates.