Lesson from the New York City Out-of-Hospital Uncontrolled Donation after Circulatory Determination of Death Program

Stephen P. Wall, Bradley J. Kaufman, Nicholas Williams, Elizabeth M. Norman, Alexander J. Gilbert, Kevin G. Munjal, Shana Maikhor, Michael J. Goldstein, Julia E. Rivera, Harvey Lerner, Chad Meyers, Marion Machado, Susan Montella, Marcy Pressman, Lewis W. Teperman, Nancy N. Dubler, Lewis R. Goldfrank, Victoria Tuttle, Ronald J. Simon, Julian BazelJohn Freese, Abbey Handelsman, Allison Levin, Luis Matallana, David Prezant, Grant Simmons, Charles J. Gonder, Ziph Hedrington, David O'Hara, Maria E. Sabeta, Christopher L. Smith, Maria Torres, Yuriy Yushkov, NYC uDCDD Study Group

Research output: Contribution to journalArticle

Abstract

Study objective In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. Methods We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. Results The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%). Conclusion In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.

Original languageEnglish (US)
Pages (from-to)531-537.e39
JournalAnnals of Emergency Medicine
Volume67
Issue number4
DOIs
StatePublished - Apr 1 2016

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Organ Preservation
Urban Hospitals
Tissue and Organ Procurement
Emergency Medical Services
Kidney
Telecommunications
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Health Services Research
Heart Arrest
Resuscitation
Population

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Lesson from the New York City Out-of-Hospital Uncontrolled Donation after Circulatory Determination of Death Program. / Wall, Stephen P.; Kaufman, Bradley J.; Williams, Nicholas; Norman, Elizabeth M.; Gilbert, Alexander J.; Munjal, Kevin G.; Maikhor, Shana; Goldstein, Michael J.; Rivera, Julia E.; Lerner, Harvey; Meyers, Chad; Machado, Marion; Montella, Susan; Pressman, Marcy; Teperman, Lewis W.; Dubler, Nancy N.; Goldfrank, Lewis R.; Tuttle, Victoria; Simon, Ronald J.; Bazel, Julian; Freese, John; Handelsman, Abbey; Levin, Allison; Matallana, Luis; Prezant, David; Simmons, Grant; Gonder, Charles J.; Hedrington, Ziph; O'Hara, David; Sabeta, Maria E.; Smith, Christopher L.; Torres, Maria; Yushkov, Yuriy; NYC uDCDD Study Group.

In: Annals of Emergency Medicine, Vol. 67, No. 4, 01.04.2016, p. 531-537.e39.

Research output: Contribution to journalArticle

Wall, SP, Kaufman, BJ, Williams, N, Norman, EM, Gilbert, AJ, Munjal, KG, Maikhor, S, Goldstein, MJ, Rivera, JE, Lerner, H, Meyers, C, Machado, M, Montella, S, Pressman, M, Teperman, LW, Dubler, NN, Goldfrank, LR, Tuttle, V, Simon, RJ, Bazel, J, Freese, J, Handelsman, A, Levin, A, Matallana, L, Prezant, D, Simmons, G, Gonder, CJ, Hedrington, Z, O'Hara, D, Sabeta, ME, Smith, CL, Torres, M, Yushkov, Y & NYC uDCDD Study Group 2016, 'Lesson from the New York City Out-of-Hospital Uncontrolled Donation after Circulatory Determination of Death Program', Annals of Emergency Medicine, vol. 67, no. 4, pp. 531-537.e39. https://doi.org/10.1016/j.annemergmed.2015.09.017
Wall, Stephen P. ; Kaufman, Bradley J. ; Williams, Nicholas ; Norman, Elizabeth M. ; Gilbert, Alexander J. ; Munjal, Kevin G. ; Maikhor, Shana ; Goldstein, Michael J. ; Rivera, Julia E. ; Lerner, Harvey ; Meyers, Chad ; Machado, Marion ; Montella, Susan ; Pressman, Marcy ; Teperman, Lewis W. ; Dubler, Nancy N. ; Goldfrank, Lewis R. ; Tuttle, Victoria ; Simon, Ronald J. ; Bazel, Julian ; Freese, John ; Handelsman, Abbey ; Levin, Allison ; Matallana, Luis ; Prezant, David ; Simmons, Grant ; Gonder, Charles J. ; Hedrington, Ziph ; O'Hara, David ; Sabeta, Maria E. ; Smith, Christopher L. ; Torres, Maria ; Yushkov, Yuriy ; NYC uDCDD Study Group. / Lesson from the New York City Out-of-Hospital Uncontrolled Donation after Circulatory Determination of Death Program. In: Annals of Emergency Medicine. 2016 ; Vol. 67, No. 4. pp. 531-537.e39.
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abstract = "Study objective In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. Methods We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. Results The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98{\%} (95{\%} credible interval 76{\%} to 100{\%}). Conclusion In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.",
author = "Wall, {Stephen P.} and Kaufman, {Bradley J.} and Nicholas Williams and Norman, {Elizabeth M.} and Gilbert, {Alexander J.} and Munjal, {Kevin G.} and Shana Maikhor and Goldstein, {Michael J.} and Rivera, {Julia E.} and Harvey Lerner and Chad Meyers and Marion Machado and Susan Montella and Marcy Pressman and Teperman, {Lewis W.} and Dubler, {Nancy N.} and Goldfrank, {Lewis R.} and Victoria Tuttle and Simon, {Ronald J.} and Julian Bazel and John Freese and Abbey Handelsman and Allison Levin and Luis Matallana and David Prezant and Grant Simmons and Gonder, {Charles J.} and Ziph Hedrington and David O'Hara and Sabeta, {Maria E.} and Smith, {Christopher L.} and Maria Torres and Yuriy Yushkov and {NYC uDCDD Study Group}",
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T1 - Lesson from the New York City Out-of-Hospital Uncontrolled Donation after Circulatory Determination of Death Program

AU - Wall, Stephen P.

AU - Kaufman, Bradley J.

AU - Williams, Nicholas

AU - Norman, Elizabeth M.

AU - Gilbert, Alexander J.

AU - Munjal, Kevin G.

AU - Maikhor, Shana

AU - Goldstein, Michael J.

AU - Rivera, Julia E.

AU - Lerner, Harvey

AU - Meyers, Chad

AU - Machado, Marion

AU - Montella, Susan

AU - Pressman, Marcy

AU - Teperman, Lewis W.

AU - Dubler, Nancy N.

AU - Goldfrank, Lewis R.

AU - Tuttle, Victoria

AU - Simon, Ronald J.

AU - Bazel, Julian

AU - Freese, John

AU - Handelsman, Abbey

AU - Levin, Allison

AU - Matallana, Luis

AU - Prezant, David

AU - Simmons, Grant

AU - Gonder, Charles J.

AU - Hedrington, Ziph

AU - O'Hara, David

AU - Sabeta, Maria E.

AU - Smith, Christopher L.

AU - Torres, Maria

AU - Yushkov, Yuriy

AU - NYC uDCDD Study Group

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Study objective In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. Methods We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. Results The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%). Conclusion In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.

AB - Study objective In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. Methods We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. Results The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%). Conclusion In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.

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