Expanding the DCD donor pool: prediction of time to death after removal of life-sustaining treatments

Dear Editor, The growing need for transplantable organs from deceased donors along with convincing outcomes of recipients drives the quest for expanding the donor pool [1–3]. Since the revision of the Law for Organ Transplantation enacted in April 2013 in the Czech Republic, a controlled donation after circulatory death (DCD) may address the shortage of deceased donor organs for transplantation. A recommendation for withdrawing lifesustaining treatments (WLST) has existed in the Czech Republic since 2010 and a national protocol for donation after circulatory death has been available since November 2013. As there is important variability in the practical aspects of WLST in the intensive care unit in different countries [3] and because death after WLST must occur within a certain time frame (1–2 h) for DCD to proceed successfully [4, 5], we aimed to determine specific predictors of time to death after WLST in adult patients with a hopeless prognosis. The study was approved by the ethics committee. We conducted a two-center prospective longitudinal cohort study between April 2013 and January 2014. In 107 consecutive adult patients in whom a decision for WLST was made, we prospectively recorded demographics (age, gender, reason for admission, reason for WLST, comorbidities), days in ICU, days on mechanical ventilation, the last measures in the clinical record before WLST: GCS, ventilator parameters (PEEP, FiO2, PaO2, and spontaneous respiratory rate), circulatory variables (heart rate, MAP, dose of vasopressors), lab results (pH, lactate, creatinine, liver function tests, and current sedation or analgesia dose). The opinion of the ICU clinician and nurse was also used as a predictor variable. The primary outcome variable was death within 60 min of WLST. Wilcoxon–Mann–Whitney twosample two-sided test of median equality was used at a significance level of 0.05 for evaluation of