Utilization rate of uncontrolled donors after circulatory death‐a 3‐year single‐center investigation

Abstract

BackgroundEffectiveness of uncontrolled donation after circulatory death (uDCD) has been recently reported to be 75% according to data coming from some European countries in 2016, but few data are to date available on this topic.MethodsWe assessed the utilization rate (as the percentage of donors who were converted into actual donors) in 37 uDCDs consecutively enrolled at our Center (Careggi Teaching Hospital) from June 2016 to June 2019.ResultsIn three cases, the family did not give consent for donation (3/37, 8.1%). Among the 37 potential uDCDs, 22 became actual donors (22/37, 59%), with 10 livers and 38 kidneys being transplanted, respectively. Fifteen livers were recovered (15/37, 68%), and 10 livers were transplanted (10/15, 67%). Forty‐two kidneys were procured and 38 organs transplanted. The overall effectiveness was 78%.ConclusionsAccording to our 3‐year experience, uncontrolled DCDs do represent an additional means of increasing the number of transplanted organs (kidneys and livers) with an acceptable utilization rate. Research on organ viability assessment (for both livers and kidneys from uDCDs) is still in its infancy, and there is probably space for a further wider use of organs from uDCDs.

Liver viability using normothermic regional perfusion in uncontrolled donation after circulatory death deserves a multi‐parametric assessment

“…In addition, fluid administration and increased intraabdominal pressures during procurement should also be included to assess organ viability, as they might imply more severe ischemic injury and a critically injured liver. 4 The role of lactates in the assessment of NRP efficacy has correctly been downgraded by the Authors, and this was recently confirmed by our experience. 5 tors (i.e., small bowel and/or limb ischemia), while an improved lactate uptake ratio and a trend toward end-of-procurement lower lactate levels should integrate assessment of liver viability.…”

Donor eligibility criteria and liver graft acceptance criteria during normothermic regional perfusion: A systematic review

“…Of the 14 studies published between 2003 and 2021, 12 studies (86%) were published after 2014 (Table 1). [10][11][12][13][14][15][16][17][18][19][20][21][22][23] All study designs were retrospective cohort studies. No randomized clinical trials were found.…”

Normothermic regional perfusion in liver transplantation from donation after cardiocirculatory death: Technical, biochemical, and regulatory aspects and review of literature

“…In published protocols, 44,45,47–52 they are measured immediately before starting NRP, after 1 h, and at the end of reconditioning. More frequent measurements are also reported 19–53 . Barcelona's team 44,45 adopted a threshold based on a maximum of three times the upper limit of normality at baseline and of four times at the end of NRP.…”

“…19,25 According to circuit design, the use of heparincoated versus non-coated tubing is possible and an oxygen/air mixture is delivered through the oxygenator. 25 A graft discard rate of 1.5%-5.6% due to technical problems during NRP was reported in literature. 28,29 The main issues were cannulation and balloon occlusion failure, highlighting the importance of appropriate training and experience in the technical management of NRP.…”