The transplantation of organs is a major medical advancement and allows lives to be saved. At the same time, there are not enough organs that can be transplanted compared to the numbers needed, and patients die while awaiting transplants. From this stems a need to define further situations where organs are able to be harvested. In this way the concept of heart donation after circulatory death (DCD) was born, or more specifically, Maastricht I, II, and III.
Maastricht III applies in the case where, following a decision to stop treatment in intensive care, life-sustaining measures that are keeping the patient alive are withdrawn. Cardiac arrest follows. Under Maastricht III, the decision to stop treatment and thus allow death is overlaid with the decision for organ recovery.
The project entails establishing the “Maastricht III Non-Beating Heart Donors” program in the Intensive Care Division, so as to allow for more donors at the HUG. Projections based on patients who have died in this Division in recent years indicate that the number of donors from intensive care could increase from 50 to 100%, which would represent around twenty donors per year. Organ donation after circulatory death is psychologically difficult and for healthcare personnel it can involve a conflict between duty to the dying patient they were treating and perceived duty to the patient awaiting the organ. We have therefore planned, among other measures, 3 years of funding for a nurse coordinator position in order to limit the psychological stress the program might cause personnel and families.
Where we are:
The Maastricht III project has been in place for 2 years. It made it possible to increase the general consent rate in Geneva to 70%, compared to 46% in Switzerland overall, in the first semester of 2017.
Dr. Yvan Gasche, Deputy Head Physician and Clinical Professor, Intensive Care Division, Department of Anesthesiology, Pharmacology, and Intensive Care, Geneva University Hospitals