Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation

TO THE EDITOR:

Jabre and colleagues (1) attempted to determine criteria to identify patients with out-of-hospital cardiac arrest with no chance of survival to orient them toward organ donation. Indeed, the worldwide penury of organs is a major health issue (2). Furthermore, the authors highlight that stopping attempts at cardiopulmonary resuscitation in these patients may be reasonable considering the almost nonexistent chances of survival. The main problem is that these termination rules do not consider organ donation and that delays in identifying patients in whom resuscitation is futile lead to loss of potential donors (3, 4). The authors identified 3 criteria linked to lack of survival: out-of-hospital cardiac arrest not witnessed by emergency medical services personnel, nonshockable rhythm at first assessment by these personnel, and no sustainable return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine. They observed a 0% survival rate in their 2 study cohorts and their external validation cohorts. Hence, they concluded that emergency medical services personnel should implement their criteria. This way, all patients who meet these criteria whose organs are probably suitable for transplantation would be considered for organ donation.