Donation after circulatory death: An international view

Abstract

The blossoming transplantation enterprise has increased the demand for human organs beyond those available from living donors. While individuals undergoing donation after brain death (DBD) continue to yield the vast majority of cadaveric organs recovered worldwide, a growing practice recruits donors among patients displaying severe brain injury but not meeting the criterion of electrosilence. These patients include a cohort who cannot maintain their circulation after withdrawal of machine-assisted ventilation and whose families consent to organ retrieval – subjects for donation after cardiocirculatory death (DCD). Expositions in this collection of articles in Transplantation Reports reveal variable practices worldwide, not only in surgical procedures to recover DCD organs, but also to overcome the ischemia-reperfusion injuries (IRi) consequent to retrieval. The contributions reveal center, national and international guidelines for, as well as outcomes of kidney, liver, lung, cardiac and pancreas transplantations of DCD organs in The United States, South America, Europe, Asia and The Middle East.

On the one hand, there is little concern about the use of ex vivo machine perfusion to diagnose, mitigate and treat IRI in DCD organs. On the other hand, in vivo donor re-vitilization by cardiopulmonary bypass after declaration of death has incited considerable controversy even among medical professionals. Bioethical and biophilosophical considerations as well as public opinion and social consensus must inform forthcoming deliberations of The United States Uniform Determination of Death Act (UDDA) Commission in order to place DCD procedures on a firm footing to meet burgeoning patient needs.