Organ donation after circulatory death

Abstract

There is an ongoing shortfall of organs for donation in the UK and worldwide. Strategies including donation after circulatory death (DCD), living donation and better identification of potential donors are attempting to increase the number of donors and donated organs. The number of DCD donors in the UK increased by 808% from 37 to 336 between 2001 and 2010 and this is continuing to increase. The most common organs donated from DCD donors are the kidneys, but there is increasing experience of liver, lung and pancreas transplantation. The process of DCD varies between different countries and institutions. The outcome of DCD transplantation has been largely encouraging, particularly for kidneys. The increase in DCD has led to an appraisal of issues that may arise during the donation process; these include the Lazarus phenomenon, the dead donor rule, perimortem interventions, public opinion and conflict of interest for clinicians.

Family Perspectives on Deceased Organ Donation: Thematic Synthesis of Qualitative Studies

“…The studies included in the review did not differentiate between family experiences of donation after brain death and donation after cardiac death. In some countries, donation after cardiac death has been used as a strategy to increase transplantation rates ; therefore, we suggest further research focused on family perspectives on donation after cardiac death is needed.…”

First Russian experience of liver and kidneys transplantation obtained from the donor with out-of-hospital irreversible cardiac arrest

“…В большинстве стран, начавших работу с данными протоколами, и в настоящее время существуют нерешенные конкретные этические, юридические и логистические проблемы [17,19]. Эти проблемы, если они не будут решены, могут помешать дальнейшему внедрению данных протоколов [31].…”

“…Протоколы работы с АСД в настоящее время успешно реализованы в Испании, Франции, Италии, Великобритании и Нидерландах [16]. Международный опыт показал, что использование АСД является эффективным способом увеличения количества эффективных доноров [17]. Однако результативность данных программ сопряжена с созданием сложных логистических схем взаимодействия различных служб, таких как скорая медицинская помощь, стационарные отделения скорой медицинской помощи («красной зоны» -реанимации, режим работы 24/7), отделения органного донорства (режим работы 24/7), отделения трансплантации (режим работы 24/7).…”

Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes

“…All of the reviewed guidelines included specific concerns with ethical, legal, and logistic implications. Many authors [ 5 – 7 , 9 , 22 , 23 , 31 , 35 – 53 ] have pointed out that protocols for uDCD entail specific challenges. These issues, if unresolved, may hinder further worldwide development of uDCD strategy [ 9 ].…”

“…Protocols have also been developed in other countries, such as Belgium, Switzerland, and Austria, and in Saint Petersburg (Russia) and in New York City [ 4 ]. These international experiences have demonstrated that uDCD is an effective way to increase the availability of solid organs for transplantation [ 5 ]. Although uDCD appears to have promising results in terms of graft survival, it raises several medical, ethical, legal, economic, and logistic challenges at the intersection of cardiac arrest, resuscitation, organ donation, and organ preservation after declaring death [ 6 , 7 ].…”