A Donation After Circulatory Death Program Has the Potential to Increase the Number of Donors After Brain Death*

Broderick, Andrew; Manara, Alex; Bramhall, Simon R.; Cartmill, Maria; Gardiner, Dale; Neuberger, James

doi:10.1097/ccm.0000000000001384

Cited by 25 publications

(15 citation statements)

References 12 publications

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“…In the early days of the program, patient and graft outcomes were inferior to recipients of DCD livers, but with increasing experience and improved techniques this difference is decreasing. The DCD program was developed to ensure that the organ donation and transplantation occurs whenever appropriate, but a prospective audit showed no evidence that the presence of an active DCD program results in a switch of donors from DBD to DCD …”

Section: Challengesmentioning

confidence: 99%

“…Measures adopted to improve consent rates include changing public behavior to support organ donation, removing actual or perceived objections to donation, and ensuring that every potential donor is identified and that the family is approached by personnel who are trained to seek consent whenever appropriate. The lack of intensive therapy unit (ITU) beds remains an issue: for example, a study in 2010 showed the United Kingdom has 3 ITU beds per 100,000 population compared with 25 beds per 100,000 population in Germany . The shortage of beds has significant implications on donation because this may affect how end‐of‐life care is administered.…”

Section: Challengesmentioning

confidence: 99%

“…The DCD program was developed to ensure that the organ donation and transplantation occurs whenever appropriate, but a prospective audit showed no evidence that the presence of an active DCD program results in a switch of donors from DBD to DCD. (10) The wider use of effective treatments for hepatitis C virus, the increase in the number of patients with nonalcoholic fatty liver disease, and more effective therapies for the treatment of liver cell cancer will variously affect the waiting list.…”

Section: Challengesmentioning

confidence: 99%

“…The lack of intensive therapy unit (ITU) beds remains an issue: for example, a study in 2010 showed the United Kingdom has 3 ITU beds per 100,000 population compared with 25 beds per 100,000 population in Germany. (10) The shortage of beds has significant implications on donation because this may affect how end-of-life care is administered. Work is continuing to assess organ donation from uncontrolled deceased donors in emergency departments.…”

Section: Current Developments and Prioritiesmentioning

confidence: 99%

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Liver transplantation in the United Kingdom

Neuberger

2016

Liver Transpl

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Liver transplantation (LT) services in the United Kingdom are provided by 7 designated transplant centers for a population of approximately 64 million. The number of deceased organ donors has grown, and in 2014-2015 it was 1282 (570 donation after circulatory death and 772 donation after brain death). Donor risk is increasing. In 2014-2015, there were 829 LTs from deceased and 38 from living donors. The common causes for transplantation are liver cell cancer, viral hepatitis, and alcohol-related liver disease. Livers are allocated first nationally to super-urgent listed patients and then on a zonal basis. The United Kingdom will be moving toward a national allocation scheme. The median interval between listing and transplantation is 152 days for adults awaiting their first elective transplant. Of the adults listed for the first elective transplant, 68% underwent transplantation at < 1 year; 17% are waiting; and 4% and 11% were removed or died, respectively. The 1-and 5-year adult patient survival rate from listing is 81% and 68%, respectively, and from transplantation is 92% and 80%, respectively. The transplant program is funded through general taxation and is free at the point of care to those who are eligible for National Health Service (NHS) treatment; some have to pay for medication (up to a maximum payment of US $151/year). The competent authority is the Human Tissue Authority which licenses donor characterization, retrieval, and implantation; transplant units are commissioned by NHS England and NHS Scotland. National Health Service Blood and Transplant (NHSBT) promotes organ donation, maintains the organ donor register, obtains consent, and undertakes donor characterization and offering. NHSBT also maintains the national waiting list, develops and applies selection and allocation policies, monitors outcomes, and maintains the UK National Transplant Registry and commissions a national organ retrieval service.

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Section: Challengesmentioning

confidence: 99%

Section: Challengesmentioning

confidence: 99%

Section: Challengesmentioning

confidence: 99%

Section: Current Developments and Prioritiesmentioning

confidence: 99%

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Liver transplantation in the United Kingdom

Neuberger

2016

Liver Transpl

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“…Of those 257, 134 proceeded as an organ donor. "A donation after circulatory death program has the potential to increase the number of donors after brain death" may be a somewhat misleading title to the study by Broderick et al (4). Perhaps the most important question, these researchers asked in this study was whether any of the DCD donors could have become DBD donors.…”

mentioning

confidence: 89%