Liver Transplant Using Donors After Unexpected Cardiac Death: Novel Preservation Protocol and Acceptance Criteria

Fondevila, Constantino; Hessheimer, Amelia J.; Ruíz, Ángel; Calatayud, David G.; Ferrer, J.; Charco, Ramón; Fuster, J.; Navasa, Miguel; Rimola, Antoni; Taurà, Pilar; Ginès, Pere; Manyalich, M.; García‐Valdecasas, Juan Carlos

doi:10.1111/j.1600-6143.2007.01846.x

Cited by 281 publications

(206 citation statements)

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“…The indications for OLT in this group were alcoholic cirrhosis (n ϭ 18), hepatitis C cirrhosis (n ϭ 13), hepatitis B cirrhosis (n ϭ 6), hepatocellular carcinoma (n ϭ 2), and cryptogenic cirrhosis (n ϭ 1). The mean Child-Pugh score was 8.7 Ϯ 1.9 (range, [6][7][8][9][10][11][12], and the mean MELD score was 15.5 Ϯ 4.6 (range, 9-30).…”

Section: Recipient Characteristicsmentioning

confidence: 99%

“…[4][5][6][7] After unrecovered cardiac arrest is diagnosed, the donor is transferred to our center. During transportation, advanced cardiopulmonary resuscitation is performed, and it is interrupted at our center for only 5 minutes for the declaration of death according to Spanish law.…”

Section: Octubre University Hospital Protocolmentioning

confidence: 99%

“…A subsequent study of 10 patients using only chest-abdominal compression-decompression for donor maintenance raised both graft and recipient survival up to 90%. 5 More recently, Fondevilla et al 6 published their experience with 10 patients who received a UNHBD liver graft. They reported cumulative graft and patient survival rates at 1 year of 50% and 70%, respectively.…”

mentioning

confidence: 99%

“…According to previous clinical and experimental models, [4][5][6] we initially adopted a maximum normothermic extracorporeal ischemia time of 4 hours. Nevertheless, on the basis of our own results, we extended this maximum time by 30 more minutes.…”

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confidence: 99%

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Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

et al. 2009

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Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n ϭ 1) for the UNHBD group and 0% for the BDD group (P ϭ 0.15). The rate of primary nonfunction was 10% (n ϭ 2) in UNHBD recipients and 2.5% (n ϭ 1) in BDD recipients (P ϭ 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P ϭ 0.012). After a mean follow-up of 330.4 Ϯ 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P ϭ 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P ϭ 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.

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Section: Recipient Characteristicsmentioning

confidence: 99%

Section: Octubre University Hospital Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation

et al. 2009

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“…29,30 ECMO was originally designed to provide cardiorespiratory support to individuals with reversible cardiorespiratory failure. The use of ECMO in DCD is problematic because it artificially replaces circulatory function analogous to a ventilator in patients with severe brainstem or spinal cord injuries.…”

Section: Declaration Of Deathmentioning

confidence: 99%

Ethical Controversies in Organ Donation After Circulatory Death

Antommaria¹,

Fallat²,

Katz³

et al. 2013

Pediatrics

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The persistent mismatch between the supply of and need for transplantable organs has led to efforts to increase the supply, including controlled donation after circulatory death (DCD). Controlled DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria. Two central ethical issues in DCD are when organ recovery can begin and how to manage conflicts of interests. The “dead donor rule” should be maintained, and donors in cases of DCD should only be declared dead after the permanent cessation of circulatory function. Permanence is generally established by a 2- to 5-minute waiting period. Given ongoing controversy over whether the cessation must also be irreversible, physicians should not be required to participate in DCD. Because the preparation for organ recovery in DCD begins before the declaration of death, there are potential conflicts between the donor’s and recipient’s interests. These conflicts can be managed in a variety of ways, including informed consent and separating the various participants’ roles. For example, informed consent should be sought for premortem interventions to improve organ viability, and organ procurement organization personnel and members of the transplant team should not be involved in the discontinuation of life-sustaining treatment or the declaration of death. It is also important to emphasize that potential donors in cases of DCD should receive integrated interdisciplinary palliative care, including sedation and analgesia.

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