Eligible DBD Donors Proceeding via the DCD Pathway: Incidence, Cause, and Outcomes in the United Kingdom

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Background: Eligible donation after brain death (DBD) donors may rarely proceed via the donation after circulatory death (DCD) pathway. The incidence, reasons for pathway divergence, and graft and recipient outcomes in the United Kingdom of this cohort are unknown. We aimed to establish the incidence of eligible DBD to DCD donors in the United Kingdom, the reasons for pathway divergence, organ donation and utilization rates, and the renal graft and recipient outcomes for this cohort. Methods: UK electronic and article records were reviewed for all eligible DBD donors proceeding via the DCD pathway from 2012 to 2022. Incidence and stated reasons for pathway divergence, including direct family quotations and time to mechanical asystole, were recorded. These data, in addition to organ donation and utilization rates and those pertaining to renal graft and recipient survival rates, were compared with "standard DCD" and "standard DBD" control groups. Results: One hundred twenty-three eligible DBD donors proceeded via the DCD pathway, overwhelmingly due to a familial desire to be present at mechanical asystole. Median time to asystole was comparable between the cohort and DCD control groups, but the range of times was considerably shorter in the cohort group. Donation and utilization rates were similar between all groups except for the notably lower rates in liver donation for DCD control. Graft and recipient survival rates were similar for all groups, but there was a nonsignificant reduction in delayed graft function (DGF) for the cohort versus DCD control and a significant reduction in DGF for the DBD versus DCD control groups. Conclusions: Eligible DBD donors proceeding via the DCD pathway is a rare event in the United Kingdom and overwhelmingly occurs due to a familial desire to witness asystole. This cohort proceeded to asystole more reliably within acceptable time periods for donation, have higher donation and utilization rates for liver grafts, and may show reduced rates of DGF for renal grafts versus "standard DCD" groups.

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