Introduction: The NSW Organ and Tissue Donation Service (OTDS) implemented the use of fWIT in November 2022 to align with the release of the National Best Practice Guideline for the Donation after Circulatory death determination in Australia. Edition 1 October 2021 and to begin to come in line with international best practice.
Prior to the implementation of fWIT, the OTDS utilised “agonal time” (time period between withdrawal of cardiorespiratory support and cessation of circulation) which was limited to <60 mins.
The proposal calculation for fWIT in NSW is for the systolic blood pressure to reach 50mmHg within 60 mins of extubation and for circulatory standstill to occur at a maximum of 60 minutes equalling to 120 minutes total.
A retrospective review of DCDD cases for the period 2017-2022 was performed in which potential donors that died >60mins & <120mins post withdrawal of cardiorespiratory support were analysed. This revealed that there were 12 donors or 24 kidneys that may have been suitable to add to the kidney donor pool.
Method: Consultations with stakeholders that would be directly affected by this change in practice  i.e. Health Departments, Intensive care units, Organ retrieval teams, Operating Theatres, Renal Transplant units and Donation staff occurred. Identified impacts and risks associated with this change in practice were identified and addressed through education sessions and guideline production. All stakeholders essentially were agreeable to the change in practice as this was an ideal outcome for donor families and kidney transplant recipients.
Results: Since the implementation of fWIT until 31st March 2023, NSW has facilitated seventeen (17) DCDD donors. Sixteen (16) cases died within 60 mins of withdrawal of cardiorespiratory support. One (1) case died using the fWIT and died at 98mins -enabling 2 kidneys to be allocated and transplanted that would not have normally been retrieved.
Conclusion: In the 5 months since implementation of fWIT in NSW, we have not seen a marked increase in kidney donation rates. In time, with education and reframing the predictability of death by the Intensive Care physicians from 60 mins to 120 mins these numbers may increase. Further analysis and review of processes at the 12 month mark  may lead to further extension of the fWIT and therefore further kidneys available for transplant.   

Reference: Organ and Tissue Authority. “Best practice guideline for donation after circulatory determination of death ( DCDD) in Australia”: 2021  https://www.donatelife.gov.au/for-healthcare-workers/clinical-guidelines-and-protocols/national-guideline-donation-after-circulatory-death