Abstract

Background: Deceased organ donation plays a critical component in addressing donor organ shortages, but it often faces challenges in timing and consent processes. At our center, a “delayed donation” protocol was developed that would facilitate a natural progression towards brain death by temporarily delaying the withdrawal of life-sustaining therapy in intensive care unit (ICU) patients where brain death is anticipated but not immediate. This protocol relies on a clearly outlined “Do-Not-Resuscitate (DNR) Code 4” practice, which ensures ethical and informed management of potential donors and their families.

Methods: A retrospective, single-center analysis of our experience with delayed donation through a DNR 4 protocol at AZ Delta Roeselare, Belgium. We retrospectively analyzed all potential deceased donors evaluated at our ICU between January 1, 2009 and December 31, 2022.

Results: Among 415 potential donors, 84 patients were managed through the delayed donation pathway, of whom 40 progressed to brain death and were classified as delayed DBD (dDBD) donors. The use of DNR 4 allowed for an ethical extension of care, resulting in additional DBD donations without compromising family consent or patient comfort. The number of effective dDBD donations accounted for 10% of all potential donors and 19% of effective donations during the study period, contributing to stable DBD numbers in our center.

Conclusion: The DNR 4 protocol within the delayed donation framework holds potential to increase DBD opportunities and addressing donor shortages in an ethical manner. It ensures clear communication with families and maintains respect for donor autonomy while facilitating optimal donor organ recovery.