The need and opportunity for donation after circulatory death worldwide

Manyalich, M.; Nelson, Helen M.; Delmonico, Francis L.

doi:10.1097/mot.0000000000000486

Cited by 55 publications

(37 citation statements)

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“…Donation after circulatory death (DCD) donors have expanded the donor pool. However, use of these livers remains cautious in the United States . The number of DCD donors has doubled in the last decade (642 [8% of 8017 total donors] in 2006 versus 1684 [17% of 9971 total donors] in 2016); only 27% (518/1884) of the DCD livers were transplanted in 2017 .…”

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“…However, use of these livers remains cautious in the United States . The number of DCD donors has doubled in the last decade (642 [8% of 8017 total donors] in 2006 versus 1684 [17% of 9971 total donors] in 2016); only 27% (518/1884) of the DCD livers were transplanted in 2017 . The reluctance to transplant DCD livers stems from several initial studies that published worse outcomes, mainly attributing to ischemic cholangiopathy (IC) .…”

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“…Variables such as older donor age, prolonged cold ischemia time (CIT), and donor warm ischemia time (WIT) have been identified as important risk factors associated with worse outcome, particularly for IC . However, application of these criteria has led to underuse of extended criteria donor (ECD) DCD livers . A clear trend of transplanting DCD livers from younger donors was seen nationally, and only 13% of DCD LTs were from donors >50 years of age between 2005 and 2015 (www.optn.org).…”

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Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

et al. 2019

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Use of donation after circulatory death (DCD) donor livers for transplantation has remained cautious in the United States. The aim of this study was to demonstrate the expansion of a DCD liver transplantation (LT) program with the use of extended criteria donor (ECD) DCD livers. After institutional review board approval, 135 consecutive DCD LTs were retrospectively studied. ECD DCD livers were defined as those with 1 of the following factors: donor age >50 years, donor body mass index >35 kg/m2, donor functional warm ischemia time >30 minutes, and donor liver macrosteatosis >30%. An optimization protocol was introduced in July 2011 to improve outcomes of DCD LT, which included thrombolytic donor flush and efforts to minimize ischemia times. The impact of this protocol on outcomes was evaluated in terms of graft loss, ischemic cholangiopathy (IC), and change in DCD LT volume. Of 135 consecutive DCD LTs, 62 were ECD DCDs. In total, 24 ECD DCD LTs were performed before (era 1) and 38 after the institution of optimization protocol (era 2), accounting for an increase in the use of ECD DCD livers from 39% to 52%. Overall outcomes of ECD DCD LT improved in era 2, with a significantly lower incidence of IC (5% versus 17% in era 1; P = 0.03) and better 1‐year graft survival (93% versus 75% in era 1; P = 0.07). Survival outcomes for ECD DCD LT in era 2 were comparable to matched deceased donor LT. With the expansion of the DCD donor pool, the number of DCD LTs performed at our center gradually increased in era 2 to account for >20% of the center's LT volume. In conclusion, with the optimization of perioperative conditions, ECD DCD livers can be successfully transplanted to expand the donor pool for LT.

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Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

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“…The continuing shortage of deceased donor organs for transplantation, and the limited number of potential donors after brain death, has led to a resurgence of interest in donation after circulatory death (DCD) as an effective means of expanding the potential donor pool. In 2017, close to 136,000 solid organ transplants were performed worldwide, but, according to WHO estimates, this activity is sufficient only to meet 10% of transplant need [1]. The revival in DCD was led by the Maastricht group in The Netherlands in 1995 following their classification of DCD donors.…”

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Organ donation after circulatory death: current status and future potential

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The continuing shortage of deceased donor organs for transplantation, and the limited number of potential donors after brain death, has led to a resurgence of interest in donation after circulatory death (DCD). The processes of warm and cold ischemia threaten the viability of DCD organs, but these can be minimized by well-organized DCD pathways and new techniques of in-situ organ preservation and ex-situ resuscitation and repair post-explantation. Transplantation survival after DCD is comparable to donation after brain death despite higher rates of primary non-function and delayed graft function. Countries with successfully implemented DCD programs have achieved this primarily through the establishment of national ethical, professional and legal frameworks to address both public and professional concerns with all aspects of the DCD pathway. There remains a worldwide shortage in organ availability, and it seems unlikely that expanding standard DCD programs in isolation will be sufficient to address this. It is therefore likely that reliance on extended criteria donors will increase, with the attendant imperative to minimize ischemic injury to candidate organs. Normothermic regional perfusion and ex-situ perfusion techniques allow enhanced preservation, assessment, resuscitation and/or repair of damaged organs as a way of improving overall organ quality and preventing the unnecessary discarding of DCD organs. This review will outline exemplar controlled and uncontrolled DCD pathways, highlighting practical and logistical considerations that minimize warm and cold ischemia times while addressing potential ethical concerns. Future perspectives will also be discussed. Take home message Donation after circulatory death (DCD) is an effective means of expanding the potential donor pool, and has comparable transplantation survival to donation after brain death despite higher rates of primary nonfunction and delayed graft function. Countries with successfully implemented DCD programs have achieved this primarily through the establishment of national ethical, professional and legal frameworks to address both public and professional concerns with all aspects of the DCD pathway.

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“…Organ havuzu, tüm dünyada gereken ihtiyaçları karşılamada yetersizdir. Bu nedenle "sirkülatuar ölümden sonra bağış (actual deceased donor after circulatory death: DCD)" tanımı yapılarak donör sayısı arttırılmaya çalışılmaktadır 5,6 . Türkiye'de de organ nakli ve beyin ölümü konusunda hem merkezi koordinasyon merkezlerinin çalışması, hem de tıbbi personelin eğitiminin ve farkındalığının sağlanması toplantıları ile donör sayısının artırılmasına yönelik çabalar devam etmektedir.…”

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Retrospective Analysis of Organ Donation Rates in Patients with Brain Death Diagnosis in a University Hospital

Karan

Elgin

Oflaz

et al. 2019

Uludağ Üniversitesi Tıp Fakültesi Dergisi

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Bu çalışmada, hastanemizde 01.01.2015-31.12.2017 tarihleri arasında beyin ölümü tanısı konan 48 olgunun kayıtları retrospektif incelenerek, beyin ölümü tanısı konan olguların demografik ve klinik özellikleri ile organ bağış oranları araştırıldı. Olgular ortalama 39.88±20.57 (1-84) yaşında olup, en sık iskemik veya hemorajik inme (%52.1) ve travma (%27.1) sonrası beyin ölümü gelişmişti. Yoğun bakım yatış ile beyin ölümü tanısı arasında geçen süre 35.15±33.58 saatti. Tüm olgulara apne testi yapılmış, 15 olguya (%31.25) ise destekleyici test uygulanmıştı. Yirmi olgunun ailesi (%41.7) organ bağışına olumlu yanıt vermişti. Yaş, cinsiyet, hastane yatış tanısı ve yoğun bakım yatış zamanı ile beyin ölümü saptanması arasında geçen süre aile bağış oranını etkilememişti (sırasıyla p = 0.796, p = 0.461, p = 0.078, p = 0.392). Aile onayı ile organ bağışı izni alınan 20 donörün 3'ünün organları tıbbi nedenlerle kullanılamamış, 17 donörden toplam 31 organ alınarak başka hastalara nakledilmişti. Hastanemizde organ bağış oranının aynı dönemdeki Türkiye ortalamasının (%26.4) üzerinde olduğunu, hastanın demografik verilerinin ve tanı için geçen sürenin bağış oranında etkili olmadığını saptadık. Anahtar Kelimeler: Beyin ölümü. Yoğun bakım. Organ donörü. Organ donasyonu.

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The need and opportunity for donation after circulatory death worldwide

Cited by 55 publications

References 13 publications

Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

Expanding the Donor Pool With the Use of Extended Criteria Donation After Circulatory Death Livers

Organ donation after circulatory death: current status and future potential

Retrospective Analysis of Organ Donation Rates in Patients with Brain Death Diagnosis in a University Hospital

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