Donation after cardiac death: A 29-year experience

Abstract

Objective To report the long-term outcomes of 1218 organs transplanted from donation after cardiac death (DCD) donors from January 1980 through December 2008. Methods One-thousand two-hundred-eighteen organs were transplanted into 1137 recipients from 577 DCD donors. This includes 1038 kidneys (RTX), 87 livers (LTX), 72 pancreas (PTX), and 21 DCD lungs. The outcomes were compared with 3470 RTX, 1157 LTX, 903 PTX, and 409 lung transplants from donors after brain death (DBD). Results Both patient and graft survival is comparable between DBD and DCD transplant recipients for kidney, pancreas, and lung after 1, 3, and 10 years. Our findings reveal a significant difference for patient and graft survival of DCD livers at each of these time points. In contrast to the overall kidney transplant experience, the most recent 16-year period (n = 396 DCD and 1,937 DBD) revealed no difference in patient and graft survival, rejection rates, or surgical complications but delayed graft function was higher (44.7% vs 22.0%; P < .001). In DCD LTX, biliary complications (51% vs 33.4%; P < .01) and retransplantation for ischemic cholangiopathy (13.9% vs 0.2%; P < .01) were increased. PTX recipients had no difference in surgical complications, rejection, and hemoglobin A1c levels. Surgical complications were equivalent between DCD and DBD lung recipients. Conclusion This series represents the largest single center experience with more than 1000 DCD transplants and given the critical demand for organs, demonstrates successful kidney, pancreas, liver, and lung allografts from DCD donors. (Surgery 2011;150:692-702.)

The Use of Donation After Cardiac Death Allografts Does Not Increase Recurrence of Hepatocellular Carcinoma

“…Initial enthusiasm to use these donors has then been tempered due to reported inferior outcomes mostly due to intra-and extra-hepatic biliary complications. Overall national and international outcomes as well as reports from individual programs have extensively documented complications related to utilization of these allografts (16,17). More recent reports have shown that comparable outcomes using DBD and DCD liver allografts can be achieved with appropriate donor and recipient selection as well as paying close attention to surgical technique especially during procurement (10,18).…”

Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death

“…cDCDD protocols using the rapid recovery technique and in situ cold perfusion Many cDCDD centers use the rapid recovery technique (RRT) (4,(13)(14)(15) instead of ECMO. W-LST usually occurs in the OR, but it may occur in the ICU.…”

“…After death declaration, a rapid laparotomy followed by aortic cannulation is performed, with perfusion of cold organ-preservation solution and decompression of the venous system. At other centers, instead of aortic cannulation, femoral vessels are cannulated either premortem (14,15) or postmortem (7), with a double-balloon triple-lumen (DBTL) catheter (7,15). Once death is declared, a cold preservation solution is perfused (in situ cold perfusion [ISP]), and blood is discharged through the femoral vein cannula.…”

“…Based on a review of cDCDD protocols using ECMO (1,2,9-12) and other techniques (4,(13)(14)(15) and a review of the relevant ethics literature, we analyzed these issues to inform health professionals working in cDCDD centers regarding their decision whether or how to use ECMO in cDCDD.…”

Manejo del potencial donante cadáver

“…Como siempre, la evaluación de cada caso en particular, considerando la mortalidad del paciente en espera, es fundamental para una correcta toma de decisiones 1,6,8 . En otros centros, ya existe amplia experiencia en la donación de órganos después de la muerte o paro cardiaco, pero este tema excede los objetivos de la presente revisión 9,10 .…”