Table S1. Characteristics of the patients at the time of death

Variable / 2008
N=63 / 2009
N=65 / 2010
N=99
Characteristic at Death
Site of death:
Emergency room / 28 (44.4) / 23 (35.4) / 24 (24.2)
Intensive care unit / 29 (46.0) / 38 (58.5) / 69 (69.7)
CCU-CVICU / 6 (9.5) / 4 (6.2) / 4 (6.1)
Withdraw within 24-hr of cardiac arrest * / 14 (82.4) / 19 (76) / 24 (51.1)
Medical examiner:
Offered involvement / 35 (55.6) / 37 (56.9) / 52 (52.5)
Accepted for investigation / 29 (46.8) / 26 (40.0) / 38 (38.4)
Organ-Tissue Referral:
Family available for consent / 61 (96.8) / 60 (92.3) / 92 (92.9)
Family offered organ donation / 0 / 0 / 18 (18.2)
Tissue donation referral / 4 (6.4) / 5 (7.7) / 31 (31.3)
Tissue donation consented / 3 (4.8) / 3 (4.6) / 8 (8.1)
Tissue donation referral sheet completed / 0 / 0 / 20 (20.2)
Organ & tissue donation discussion recorded † / 5 (7.9) / 6 (9.2) / 26 (26.3)
Time from extubation to death, minutes †† / 32.8 (15.3 - 201) / 26.2 (17.5 - 98.3) / 30.6 (15.3 - 205.3)

* Proportions based on 17, 25, and 47 subjects who died of a cardiac arrest in 2008, 2009, and 2010 respectively.

† Chi-square test for difference in the proportions demonstrated a significant increase in 2010 over 2008 (p<0.01)

†† Medians and interquartile ranges based on 43, 34, and 53 subjects being extubated in 2008, 2009, and 2010 respectively.

Table S2. Potential progression to heart-beating donation (GCS =3/15 and 3 or more absent brainstem reflexes)

Variable / 2008
(N=15) / 2009
(N=15) / 2010
(N=34)
Abdominal organs:
Neither liver or kidneys / 1 (6.7) / 2 (13.3) / 4 (11.8)
Liver only / 3 (20.0) / 4 (26.7) / 6 (17.7)
Normal criteria / 1 (6.7) / 1 (6.7) / 5 (14.7)
Expanded criteria / 2 (13.3) / 3 (20.0) / 1 (2.9)
Kidneys only / 1 (6.7) / 0 (0.0) / 1 (2.9)
Normal criteria / 0 (0.0) / - / 1 (2.9)
Expanded criteria / 1 (6.7) / - / 0 (0.0)
Both liver & kidneys / 10 (66.7) / 9 (60.0) / 23 (67.7)
Normal criteria / 9 (60.0) / 7 (46.7) / 14 (41.2)
Expanded criteria / 1 (6.7) / 2 (13.3) / 9 (26.5)
TOTAL / 14 (93.3) / 13 (86.7) / 30 (88.2)
Per million population* / 7.7 (4.2 – 13) / 7.0 (3.7 – 12) / 16.0 (10.8 – 22.8)
Organ donors per million population for those proceeding to brain death † £ / 3.3 (1.2 – 7.2) / 3.2 (1.2 – 7.0) / 7.5 (4.1 – 12.5)
Lungs:
Total / 5 (33.3) / 3 (20.0) / 10 (29.4)
Normal criteria †† / 1 (6.7) / 1 (6.7) / 3 (8.8)
Expanded criteria ‡ / 4 (26.6) / 2 (13.3) / 7 (20.6)
Per million population* / 2.8 (0.9 – 6.4) / 1.6 (0.3 – 4.7) / 5.3 (2.6 – 9.8)
Organs per million population for those proceeding to brain death † ££ / 1.1 (1.3 – 4.0) / 0.5 (0.01 – 3.0) / 2.7 (0.9 – 6.2)

* The numerator includes those subjects with a GCS = 3 out of a possible 15 and 3 or more absent brainstem reflexes. The northern Alberta population denominator used: 2008 - 1,813,292: 2009 - 1,856,272; 2010 – 1,880,144.

† The numerator includes 45.7% of those subjects with a GCS = 3 out of a possible 15 and 3 or more absent brainstem reflexes and is rounded to nearest person.

†† Normal criteria lungs: age < 55 years, PaO2/FIO2 >=300, and no overt medical contraindications

‡ Expanded criteria lungs required an age 55-70 or PaO2/FIO2>=250 at any age with no overt medical contraindications. Only 215 PaO2/FIO2 observations were available.

£ Comparison of potential abdominal donors in 2010 vs. the sum of 2008 and 2009, incident rate ratio (IRR) 2.28 (95% CI, 1.05 - 4.92, p=0.04)

££ Comparison of potential abdominal donors in 2010 vs. the sum of 2008 and 2009, incident rate ratio (IRR) 2.44 (95% CI, 0.96 - 6.18, p=0.06)

Table S3. Potential donation after cardiocirculatory death (DCD) donors

Variable / 2008
(N=63) / 2009
(N=65) / 2010
(N=99)
Abdominal organs:
All potential DCD donors
Neither liver or kidneys – no.(%) / 39 (61.9) / 35 (53.9) / 55 (55.6)
Liver only – no. (%) / 3 (4.8) / 2 (3.1) / 5 (5.1)
Kidneys only / 2 (3.2) / 2 (3.1) / 3 (3.0)
Both liver and kidneys / 19 (30.2) / 26 (40.0) / 36 (36.4)
Potential DCD donors dying within 60 minutes
Neither liver or kidneys / 23 (36.5) / 13 (20.0) / 22 (22.2)
Liver only / 0 / 0 / 0
Kidneys only / 0 / 0 / 0
Both liver and kidneys / 4 (6.3) / 10 (15.4) / 9 (9.1)
Potential DCD donors dying between 61-120 minutes
Neither liver or kidneys / 0 / 1 (1.5) / 4 (4.0)
Kidneys only / 3 (4.8) / 2 (3.1) / 2 (2.0)
Total * / 7 (11.1) / 12 (18.5) / 11 (11.1)
Per million population† / 3.9 (1.6 – 8.0) / 6.5 (3.3 – 11.3) / 5.9 (2.9 – 10.5)
Lungs:
Lungs / 22 (34.9) / 17 (26.2) / 21 (21.2)
Lungs (Potential DCD donors dying within 60 minutes) †† / 7 (11.1) / 5 (7.7) / 8 (8.1)
Per million population* / 3.9 (1.6 – 8.0) / 2.7 (0.9 – 6.3) / 4.3 (1.8 – 8.4)

* Comparison of potential abdominal donors in 2010 vs. the sum of 2008 and 2009, incident rate ratio (IRR) 1.13 (95% CI, 0.54 - 2.37, p=0.74)

†The northern Alberta population denominator used: 2008 - 1,813,292: 2009 - 1,856,272; 2010 – 1,880,144.

†† Comparison of potential abdominal donors in 2010 vs. the sum of 2008 and 2009, incident rate ratio (IRR) 1.30 (95% CI, 0.53 - 3.18, p=0.56)