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Maastricht Type 2 Donors: Unrealized Opportunities

The 2006 report by the Institute of Medicine (IOM), titled “Organ Donation, Opportunities for Action” (1) estimated that 22 000 of the 335 000 individuals who die annually from cardiac arrest outside of a medical facility would be suitable for organ donation. Currently donation after cardiac death (DCD) in the United States usually occurs in Maastricht Type 3 donors that die after planned withdrawal of futile cardiorespiratory support in a hospital setting. This has also been termed “controlled” DCD because the timing of the donation event is planned. Maastricht Type 2 DCD, termed “uncontrolled” because the timing of the donation event is unplanned, occurs when an individual suffers cardiac arrest outside of a hospital, receives cardiopulmonary resuscitation en route to a medical facility, but the attempted resuscitation is unsuccessful and death is declared by circulatory criteria. The IOM report suggested that the expansion of Type 2 DCD in the United States should be an imperative.