Temporal trends in time to asystole in patients considered for organ donation after circulatory death

INTRODUCTION: Prolonged time to asystole is a common barrier to successful organ donation after circulatory death, yet there have been few attempts to evaluate trends in its occurrence over time. This study investigated temporal trends in time to asystole among patients considered for donation after circulatory death in the UK (2014-2024).

METHODS: This observational study was conducted using NHS Organ Donation & Transplant (ODT) datasets. We analysed temporal trends in time to asystole and donation outcomes using descriptive statistics. Additionally, to explore evident impacts of the COVID-19 pandemic we performed pre-post comparisons and an interrupted time series (ITS) analysis.

RESULTS: Of 9466 participants, 58.5% proceeded to solid organ donation. Non-proceeding cases were primarily due to prolonged time to asystole (55.1%). Donation rates increased from 50% to 60% pre-2020 to consistently above 60% post-2022, whilst cases not proceeding due to prolonged time to asystole decreased from 25% to 20%. ITS analysis confirmed a significant post-pandemic reduction in time to asystole and a sustained drop in referrals, suggesting improved donation efficiency. Successful donors typically received higher levels of support and had lower neurological status compared to those with prolonged time to asystole.

DISCUSSION: The findings demonstrate reduced prolonged time to asystole occurrence and increased organ donation rates. Whilst there has been ongoing improvement over the study period there is evidence of a systemic change following the COVID-19 pandemic, which resulted in a smaller, more efficient referral pool. This may be attributed to better identification of suitable donors during the referral process, and while causation cannot be definitively established, the study supports ongoing evaluation and refinement of the donation pathways.