Examining The Potential for Uncontrolled Organ Donation After Out-of-Hospital Cardiac Arrest in Canada - A sub analysis of the canROC Registry

Introduction 
There were 4,352 Canadians waiting for an organ transplant in 2020. A rise in demand has led to national exploration of non-traditional pathways for organ donation in order to increase the potential pool of donors and subsequent recipients. Uncontrolled Donation after Cardiac Death (uDCD) has become a promising option in several jurisdictions worldwide—and successfully includes the utilization of the out-of-hospital cardiac arrest (OHCA) patient population. There are an estimated 40,000 OHCAs each year in Canada. A large majority are not transported by paramedics or do not survive, leaving behind a large population of potential donors eligible for uDCD.   

Objective 
To quantify the potential pool of eligible uDCD donors being missed after unsuccessful OHCA resuscitation.   Methods 
A retrospective observational cohort study is being undertaken, using pre-existing data from the Canadian Resuscitation Outcomes Consortium (CanROC) registry, a pan-Canadian registry that collects prospective OHCA data. Consecutive OHCA cases from January 1, 2016 to December 31, 2018 will be analysed. Several sets of international criteria for uDCD are being applied to the study population, in order to generate a range of potential donors. Criteria for Non-Perfused Organ Donation (NPOD) and tissue donation will also be applied to the study population.  

Results 
Preliminary analysis yielded a total study population of 9,343. 4,305 were not transported to hospital after unsuccessful resuscitation. Non-transported patients had a mean age (SD) of 48.6 (12.9); 3,044 (70.0%) male; 3,200 (74.3%) had OHCA at home and 2,294 (52.8%) had bystander CPR. Descriptive analysis will be used to examine further patient and event characteristics. Results will be reported as mean (standard deviation [SD]) or median (interquartile range [IQR]) for continuous variables and frequency (%) for categorical variables.  

Conclusions  
Preliminary review of the literature suggests that uDCD subsequent to OHCA is a viable opportunity to increase the donor pool in Canada. Presently, there is a lack of understanding of this pool of potential donors, and no programs exist in Canada to recruit from this population. In order to explore whether pursuing uDCD subsequent to OHCA as a means to improve organ donation rates is worthwhile, we must first quantify the issue. 

Chelsea Lanos ACP BSc MSc(c)--Chelsea is an Advanced Care and Community Paramedic with the County of Renfrew Paramedic Service (Ontario, Canada). She holds a Bachelor of Science from the University of Ottawa, and recently submitted her dissertation for examination as part of her candidature for an MSc in Critical Care at Cardiff University. Chelsea is a Clinical Research Assistant with The Ottawa Hospital Research Institute’s Clinical Epidemiology program. Chelsea is a strong advocate for paramedic led research, and her interests are primarily founded in out-of-hospital cardiac arrest, as well as organ and tissue donation as it relates to the role of paramedics in the setting of out-of-hospital death. In addition, Chelsea is passionate about palliative and end-of-life care at home, and the implications of medical ethics on advanced care directives in the paramedic setting.