Causes of Deceased Donors Loss before Organ Retrieval

Background: When potential brain dead donors are in line-up for organ retrieval, their loss would be such a disaster. The aim of this study was to detect the occurrence of different disorders leading to pre-retrieval donor's cardiac arrest and loss in order to prevent this energy and money wasting challenge.

Materials and methods: In this observational study, medical records of potential donors from 2001 to 2016 who were lost after transfer to Organ Procurement Unit (OPU) of Masih Daneshvari Hospital and before organ donation were reviewed and weigh of every responsible disorder was tested. Equal number of actual organ donors were randomly selected others for comparison.

Results: In 14 years of experience in organ donation, 46 (3.09%) out of 1485 potential donors were lost after their transfer to OPU with the aim of organ donation. Mean age of donors and their gender were not significantly different to actual donors (37.4 ± 17.7 versus 39.2 ± 18.4, P= 0.2). However, proportion of drug toxicity as the cause of brain death was more common in the lost donors (19.5 versus 5.3%, P= 0.001). Thirteen (28.2%) of the cases had a documented history of ischemic heart disease, which was not as common in actual donors. After excluding hypotension and diabetes insipidus, more incident disorders among the lost donors were metabolic acidosis, hypocalcaemia, hyperglycemia, thrombocytopenia, severe anemia and different presentations of coagulopathy. Clinical conditions of 47.8% of cases were flared up by different severities of acute kidney injury and mean ALT levels were significantly higher than actual donors. All the above mentioned disorders were significantly more common in lost donors than actual ones.

Conclusion: Drug toxicity, history of ischemic heart disease and occurrence of acute kidney injury are associated with more potential donors' loss before organ retrieval.