Donation after circulatory death today: an updated overview of the European landscape

Abstract

Summary Donation after circulatory death (DCD) has become an accepted practice in many countries and remains a focus of intense interest in the transplant community. The present study is aimed at providing a description of the current situation of DCD in European countries. Specific questionnaires were developed to compile information on DCD practices, activities and post‐transplant outcomes. Thirty‐five countries completed the survey. DCD is practiced in 18 countries: eight have both controlled DCD (cDCD) and uncontrolled DCD (uDCD) programs, 4 only cDCD and 6 only uDCD. All these countries have legally binding and/or nonbinding texts to regulate the practice of DCD. The no‐touch period ranges from 5 to 30 min. There are variations in ante and post mortem interventions used for the practice of cDCD. During 2008–2016, the highest DCD activity was described in the United Kingdom, Spain, Russia, the Netherlands, Belgium and France. Data on post‐transplant outcomes of patients who receive DCD donor kidneys show better results with grafts obtained from cDCD versus uDCD donors. In conclusion, DCD is becoming increasingly accepted and performed in Europe, importantly contributing to the number of organs available and providing acceptable post‐transplantation outcomes.

Strict selection criteria in uncontrolled donation after circulatory death provide excellent long‐term kidney graft survival

“…This observation is identical to all previous studies where DGF was higher in uDCD compared with DBD kidney transplantation, [10][11][12][13][14]16,24 though this had apparently no effect on graft survival in most studies. [12][13][14] Nevertheless, DGF remains a marker of injury for the renal graft during the donation procedure and therefore it might be seen as a marker reflecting the efficacy of the preservation strategy. DGF might also prolong the length of hospital stay increasing the total economic cost of the transplant procedure.…”

“…PNF is the main concern in uDCD kidney transplantation with a reported incidence ranging from 1.8% to 20% in the largest series. [11][12][13][14]16,25 Several factors such as donor age, prolonged WIT, or in situ cooling as preservation method have been related to high rates of PNF. 12,13,16 The primary reasons for our excellent results are most likely the strict admission criteria, keeping intrahospital logistics as simple as possible to minimize the WIT.…”

“…In fact, our WIT is the lowest of all largest series. [10][11][12][13][14]16,24 All of our kidneys had been preserved with NRP, which has already been associated with lower rates of PNF as compared to the use of continuous cold flush via an intra-abdominal double-balloon catheter. 9,13,16 Although our median uDCD donor age was similar to that of most published series, no donor over 60 years was included, which is known to be a risk factor for the PNF 13,15 In our study, recipients transplanted from uDCD donors tripled the probability of developing DGF in the multivariate analysis.…”

“…At all time points, P > .05 observed in our series (42%) was much lower than that previously documented. [10][11][12][13][14]16,24 We would like to emphasize again the need for strict admission criteria and the reduction of WIT. The Spanish Registry showed that 46% of kidneys transplanted from uDCD donors had a WIT >130 minutes 13 which is similar to the recent French experience (135 minutes).…”

“…High kidney discard rates also remain a challenge that lower the conversion rates of potential into utilized donors. 14,15 Several factors such as donor age, the duration of the no-flow period, prolonged warm ischemic time (WIT), and the type of preservation have been linked to higher rates of PNF and graft loss. 13,15,16 Hence, a very restrictive protocol and strict adherence to national guidelines seems to be the best option to achieve an excellent longterm graft survival in order to fully exploit the potential contribution of uDCD to donation and transplantation activities.…”