Organ donation after cardiac death: donor and recipient outcomes after the first three years of the Ontario experience

Hernadez-Alejandro, Roberto; Wall, William; Jevnikar, Anthony M.; Luke, Patrick; Sharpe, Michael D.; Russell, David; Gangji, Azeem; Cole, Edward; Kim, Sang Joseph; Selzner, Markus; Keshavjee, Shaf; Hebert, Dianne; Prasad, G. V. Ramesh; Baker, Andrew J.; Knoll, Greg; Winterbottom, Robyn; Pagliarello, Guiseppe; Payne, Clare; Zaltzman, Jeff

doi:10.1007/s12630-011-9511-9

Cited by 39 publications

(28 citation statements)

References 16 publications

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“…For Belgium, DCD activity represented 11.38% of all donors in 2006 [17] . Since its implementation four and a half years ago, DCD has accounted for 10.9% of deceased donor activity in Ontario, Canada [18] . The majority of DCD kidneys are from controlled donors meaning that the number of organs can be further increased by utilising uncontrolled donors [3,4,12,[19][20][21][22][23][24][25][26][27][28][29][30] although the associated workload is considerably more and the yield rate poorer.…”

Section: Spread Of Practicementioning

confidence: 99%

“…Given the number of ethical issues discussed above, it is important to secure the understanding and support of colleagues, hospital managers and the community. The rapid uptake of DCD in Ontario, Canada can be attributed to strong proponents in the critical care and transplantation communities [18] . In developing a paediatric DCD program, an evidence-based, consensus-building approach to setting institutional policy about DCD can address the controversies openly.…”

Section: Service Developmentmentioning

confidence: 99%

“…Fifty-six kidneys were retrieved and 53 successfully transplanted giving a discard rate of 5.7% (3/53) [21] . The series from the author's centre reported a conversion rate of 44% and discard rate of 12.9% (9/70) [12] whereas 77% (67/87) were converted in Ontario Canada [18] . The series from Madrid exhibited a high discard rate (34%) despite the use of cardiopulmonary bypass.…”

Section: Conversion Ratementioning

confidence: 99%

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Kidney donation after cardiac death

Akoh¹

2012

WJN

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There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death (DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

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Section: Spread Of Practicementioning

confidence: 99%

Section: Service Developmentmentioning

confidence: 99%

Section: Conversion Ratementioning

confidence: 99%

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Kidney donation after cardiac death

Akoh¹

2012

WJN

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“…A recent International Society for Heart and Lung Transplantation (ISHLT) DCD Registry Report included 306 recipients among ten centers worldwide (12). Several centers published their experience, most of them with excellent or at least equal results compared to brain-dead donors (5,14,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Introductionmentioning

confidence: 99%

Donors after cardiocirculatory death and lung transplantation

İnci

2017

J. Thorac. Dis.

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Abstract:The number of patients actively awaiting lung transplantation (LTx) is more than the number of suitable donor lungs. The percentage of lung retrieval rate is lower when compared to other solid organs.The use of lungs from donation after cardiocirculatory death (DCD) donors is one of the options to avoid organ shortage in LTx. After extensive experimental research, clinical application of DCD donation is becoming wider. The results from most of the centers show at least equal survival rate compared to donors from brain death. This review paper will summarize experimental background and clinical experience from DCD donors.

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“…20 This innovative practice has yet to be subjected to the study of long-term outcome and will require consensus by the anesthesiology, critical care, neurology, and transplant communities if implemented on a wider scale. 21 In this issue of the Journal, Hernandez-Alejandro et al 22 review the growth of DCD-based transplantation in the province of Ontario in the last three years, and they point out that Ontario has led Canada in this activity. From June 2006 through May 2009, the authors found that 18 hospitals in Ontario performed 67 successful DCD donations, reflecting a 77% success rate.…”

mentioning

confidence: 99%