• HoAndrew Fu WahAFWDepartment of Emergency Medicine, Singapore General Hospital, Singapore, Singapore. sophronesis@gmail.com.Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore, Singapore. sophronesis@gmail.com., TanTimothy Xin ZhongTXZ0000-0001-5938-2304Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore. timothy.tbj13@gmail.com., Ejaz Latiff, Nur Shahidah, Yih Yng Ng, Benjamin Sieu-Hon Leong, Shir Lynn Lim, Pin Pin Pek, Han Nee Gan, Desmond Renhao Mao, ChiaMichael Yih ChongMYCEmergency Department, Tan Tock Seng Hospital, Singapore, Singapore., Si Oon Cheah, Lai Peng Tham, and OngMarcus Eng HockMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore.Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore..
• Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore. sophronesis@gmail.com.
• Scand J Trauma Resus. 2021 Jul 28; 29 (1): 105105.

BackgroundOrgan donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study.MethodsUsing Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered.Results12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario, n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario, n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year).ConclusionsIn Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.© 2021. The Author(s).

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