Contemporary considerations in solid organ transplantation utilizing DCD donors

Q4 Medicine
Farjad Siddiqui , Yazan Al-Adwan , Jayanthan Subramanian , Mitchell L. Henry
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引用次数: 3

Abstract

Introduction

Donation after cardiac death (DCD) has been leading the way to help bridge the growing gap between availability of donors and recipients on waitlist. With advances in technology and our understanding of DCD donation the safety profile is growing. It is becoming an increasing viable option even in marginal settings.

Discussion

The ethos surroundings DCD is still a matter of contention but there is support and collaboration from larger societies and establishments with development of standardizing protocols. Preparation is key. Experience of the procurement and transplanting surgeons are pivotal. There are multiple moving parts and for the success of a DCD program, dedication is needed from the donor hospitals, organ procurement organizations and the transplant centers. Previous practices based on anecdotal experiences are now either supported by or refuted by increasing evidence and data, based on the development of consensus-based guidelines with the end goal of having uniform outcomes. Normothermic regional and machine perfusion have expanded options in the DCD world, challenging the limits and expanding our paradigm. Recognition of the weaknesses and organ specific complications allow the clinician to make choices for optimal outcomes. These advancements have allowed outcomes to be optimized.

Conclusions

Expanding the organ donor pool is one solution to increase the availability of organs for transplantation. Increasing the attention to and the use of DCD organs combined with machine and normothermic perfusion is a future strategy to obtain ongoing clinical success in organ transplantation and lower the waiting list mortality.

利用DCD供体进行实体器官移植的当代思考
心脏死亡后捐赠(DCD)一直在帮助弥合捐赠者和等待名单上接受者之间日益扩大的差距。随着技术的进步和我们对DCD捐赠的了解,安全性正在提高。即使在边缘地区,它也日益成为一种可行的选择。讨论围绕DCD的精神仍然是一个有争议的问题,但是随着标准化协议的发展,有更大的社会和机构的支持和合作。准备是关键。经验的采购和移植外科医生是关键。DCD项目有多个活动部分,要想成功,需要捐赠医院、器官采购组织和移植中心的奉献精神。以往基于轶事经验的做法,现在要么得到越来越多的证据和数据的支持,要么受到越来越多的证据和数据的驳斥,这些证据和数据的基础是制定以达成一致结果为最终目标的基于共识的准则。常温区域和机器灌注扩展了DCD世界的选择,挑战了极限并扩展了我们的范式。对弱点和器官特异性并发症的认识使临床医生能够做出最佳结果的选择。这些进步使结果得以优化。结论扩大供体库是提高移植器官供应的有效途径之一。增加对DCD器官与机器和常温灌注相结合的关注和使用是未来器官移植获得持续临床成功和降低等候名单死亡率的策略。
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来源期刊
Transplantation Reports
Transplantation Reports Medicine-Transplantation
CiteScore
0.60
自引率
0.00%
发文量
24
审稿时长
101 days
期刊介绍: To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI
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