Thoracic organ donation after circulatory determination of death

The availability of thoracic organ transplantation as the treatment of choice for end-stage cardiac or pulmonary diseases is limited by the insufficient number of donor organs from brain dead donors, especially for organs where live-donation is not an option. Patients, who have not progressed to brain death, but have exhausted therapeutic options and life sustaining therapies are withdrawn can become donors with circulatory determination of death (DCD) when they meet criteria for the definition of this state. This approach can fulfill the wish of a patient to become an organ donor and also help to increase the number of donor organs. The DCD process exposes organs to prolonged warm ischemia that increases the possibility of primary graft dysfunction and failure. However, new technologies help in protecting the organs from cold preservation-related ischemia and facilitate resuscitation and monitoring of viability after the occurrence of the DCD-related ischemic insult. Herein, we review the opportunities and challenges in DCD thoracic organ transplantation, emerging techniques in preservation and monitoring of these organs and the potential effect of DCD thoracic organ transplantation on expanding the donor pool.