Uncontrolled Donation After Circulatory Death: A Unique Opportunity.

Abstract:

:Uncontrolled donation after circulatory death (uDCD) refers to donation from persons who die following an unexpected and unsuccessfully resuscitated cardiac arrest. Despite the large potential for uDCD, programs of this kind only exist in a reduced number of countries with a limited activity. Barriers to uDCD are of a logistical and ethical-legal nature, as well as arising from the lack of confidence in the results of transplants from uDCD donors. The procedure needs to be designed to reduce and limit the impact of the prolonged warm ischemia inherent to the uDCD process, and to deal with the ethical issues that this practice poses: termination of advanced cardiopulmonary resuscitation, extension of advanced cardiopulmonary resuscitation beyond futility for organ preservation, moment to approach families to discuss donation opportunities, criteria for the determination of death, or the use of normothermic regional perfusion for the in situ preservation of organs. Although the incidence of primary nonfunction and delayed graft function is higher with organs obtained from uDCD donors, overall patient and graft survival is acceptable in kidney, liver, and lung transplantation, with a proper selection and management of both donors and recipients. Normothermic regional perfusion has shown to be critical to achieve optimal outcomes in uDCD kidney and liver transplantation. However, the role of ex situ preservation with machine perfusion is still to be elucidated. uDCD is a unique opportunity to improve patient access to transplantation therapies and to offer more patients the chance to donate organs after death, if this is consistent with their wishes and values.

journal_name

Transplantation

journal_title

Transplantation

authors

Coll E,Miñambres E,Sánchez-Fructuoso A,Fondevila C,Campo-Cañaveral de la Cruz JL,Domínguez-Gil B

doi

10.1097/TP.0000000000003139

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

1542-1552

issue

8

eissn

0041-1337

issn

1534-6080

pii

00007890-202008000-00012

journal_volume

104

pub_type

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