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Organ donation after sudden irreversible cardiac arrest
Background
There is a significant shortage of organs currently available for transplantation in the UK, with more than 6000 people currently waiting for a kidney transplant. This shortfall is only likely to increase over time, as the number of people who are living with end-stage kidney disease increases.
Around 300,000 adults under the age of 80 die every year in the UK, including 30,000 from a cardiac arrest outside hospital. However, there are only around 1500 donations from deceased donors each year. These donations are all carried out in the ‘controlled’ setting of the intensive care unit, when medical treatments are withdrawn either because the patient is brain dead (donation after brain death) or because the medical life support treatments have no chance of success and so are stopped (controlled donation after circulatory death).
There is no mechanism for people who die outside of a hospital after a sudden irreversible cardiac arrest to become organ donors in the UK; some bereaved relatives have expressed frustration at this, as it means that their loved ones’ final wishes cannot be respected. Other countries – such as France and Spain – have developed protocols for donation in this situation and have called it ‘uncontrolled donation after circulatory death’ (uDCD) (to contrast it with the donations which happen in the controlled intensive care unit setting). Partly because of this, these counties have higher numbers of organ donors and shorter waiting lists for transplant recipients.
There are two ethical imperatives to consider in ‘uncontrolled donation after circulatory death’ – or what we prefer to call Organ Donation After Sudden Irreversible Cardiac Arrest or ODASICA. The first is the shortfall in available organs for people who need them. The second issue is that people who wanted to donate their organs after death are unable to do so.
There are, however, also ethical concerns about the ODASICA process, including the nature and timing of conversations with relatives, and the nature of preserving the organs before transplant which will need to be properly defined. To date there has been no research into the best ways to conduct conversations with bereaved families considering ODASICA, or how best to support healthcare staff involved in the process.
It is important to optimise the approach around uncontrolled donation after circulatory death (uDCD) so that trust in the organ donation process can be maintained, while making this an option available to people that could help to address the shortfall in available organs in the UK. This study aims to find out whether uDCD donation could be a possibility in the UK and examines the impact it has on donor families.
Approach
- We conducted a systematic review into the ethical issues around uncontrolled donation after circulatory death.
- We conducted a survey into the attitudes of the public to a range of transplant scenarios, and their views on the elements of ODASICA which could be considered ethically challenging.
- We are conducting a pilot programme of Organ Donation After Sudden Irreversible Cardiac Arrest (ODASICA) which is taking place at Cambridge University Hospitals from 2024 – 2026.
- We will conduct qualitative interviews with the relatives of the organ donors, and healthcare professionals involved in the donation process.
- We will carry out an ethical analysis of the issues that we identify throughout the process.
Project team
WT
Weiyi Tan
Clinical School, University of Cambridge
Funding and ethics
This study is funded by NHS Blood and Transplant TF Grant TF093 and Addenbrookes Charitable Trust grant 900369. Researchers are also supported by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute) and the Welcome Trust.
The study is independently led by THIS Institute and Cambridge University Hospital and reviewed by University of Cambridge Psychology REC and the NHS research committee (PRE.2024.015).