To the Editor: Opdam and Silvester concluded that the small pool of organ donors limits the potential for organ donation in Victoria.1

According to the definition of death in the Human Tissue Act 1983 (NSW):

Current cadaveric organ donation takes place predominantly after brain death, although it is also possible after cardiac death. This was previously described as “non-heart-beating organ donation”, but the name was changed to “donation after cardiac death” (DCD) to emphasise that organ donation occurs only after death.

DCD can be classified by the Maastricht criteria (Box).2 Category III is relevant in select patients undergoing planned withdrawal of therapy in intensive care units (ICUs). Planned withdrawal of therapy is said to occur in about 60% of all ICU deaths.3

Permission for organ donation is required before the planned withdrawal of life support, so the donor organ retrieval teams can be available and ready to retrieve organs soon after a 5-minute “cooling off” period after circulation ceases. These 5 minutes also allow families to spend time with the deceased after death. A period of less than 60 minutes between withdrawal of therapy and cessation of circulation is recommended to minimise warm ischaemia time in the retrieved organs. Withdrawal of life support may occur in the ICU or in the operating room complex, and local hospital guidelines should address the issue of where this occurs.

Between 1989 and 2004, 30 Australian organ donations involved non-heart-beating organ donors (data from the Australia New Zealand Organ Donor Registry). In 2005, eight New South Wales organ donations, accounting for 14% of all cadaveric renal transplantation, proceeded after cardiac death criteria were applied. In our unpublished retrospective audit, 7% of patients who had planned withdrawal of therapy in the ICU met the criteria for eligible organ donors after cardiac death. The organ donor pool for organ donation after brain death was 1.7% in Opdam and Silvester’s study.1

The long-term function of transplanted kidneys is not significantly different for organs retrieved after cardiac death compared with organs retrieved after brain death.4 Liver and lung transplantation are also possible from organs retrieved from non-heart-beating organ donors.

Draft guidelines for DCD in NSW are soon to be released by NSW Health. Similar guidelines in other states and education of staff involved in organ donation would no doubt increase the organ donation pool and the potential for organ donation.