Uncontrolled donation after circulatory death in the Tuscany region: evolving paradigms and potentials. An 8-year experience

Background: Uncontrolled DCD (uDCD) represents a potential source of organs since the global survival rates of patients with out of hospital cardiac arrest (OHCA) is estimated less than 10% across all registries. We describe our 8-year experience with the implementation of the uDCD program over the Tuscany Region since June 2016. We focus on feasibility, results (organ transplant) and organizational changes. Methods: The study population included uDCDs assessed in the Tuscany Region from 2016 to 2024. Two different periods were considered: Period 1: from 2016 to 2019; Period 2: from 2020 to 2024 (after COVID pandemic). Results: Overall, 226 potential uDCDs were assessed by the local transplant coordinators, with an increased number in Period 2 in respect to Period 1 (151 vs. 75, 67% vs. 33%). A significant increase in refusals was observed (Period 2: 25% vs. Period 1: 6%, P=0.004). The overall utilization rate was 56%. Fifty-seven kidneys were transplanted, 22 livers and two lungs. The number of organs per donor increased in Period 2 compared to Period 1. Conclusions: According to our 8-year experience, the uDCD proved to be an add-on activity, giving the opportunity to all OHCA patients without survival options to save lives by organ donation. The uDCD only lung program is a feasible chance to organ donate for OHCA patients with no survival possibility in peripheral hospital. The uDCD program, despite its complexity, seems to have potentials ranging to organizational (uDCD only lung program, mobile machine perfusion) to clinical issues (optimizing the donor-recipient match).