In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist. The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of “no-touch time,” circulatory death was declared. Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.

Background: We would like to report the first case of successful organ donation after withdrawal of life-sustaining treatment (WLST) in Korea. Methods: A 52-year-old male patient who had cerebral hemorrhage was the potential brain-dead donor. After passing the first brain death examination, according to the recommendation of a neurologist, electroencephalograms (EEG) were performed 5 times at intervals of 2 to 3 days and they did not show flat EEGs. Since the family members' willingness to donate organs was very strong, they agreed to donation after circulatory death (DCD) after WLST in the operating room (OR) without them. The patient was transferred to the OR at 7:30 PM on July 3, 2020. Surgical drape was done for the donor. At 8:00 PM, an intensivist in charge of the patient performed extubation and stopping the vasopressors at the same time. In 1 minute, oxygen saturation (SpO 2) fell below 70%, which meant functional warm ischemia time began. At 8:15 PM, asystole was confirmed, and after a 5-minute "no touch time", declaration of circulatory death was done by the intensivist at 8:20 PM. Afterwards, all recipient surgeons who were waiting with surgical gown at the next OR moved to the donor's OR and performed organ procurement surgery. Results: Aortic clamp and HTK fluid perfusion started at 8:22 PM, 2 minutes after the incision started. Liver was out at 8:56 PM and kidney was out at 9:11 PM. Organs quality were good and they were donated well to the recipients. Conclusions: Since this case started with donation after brain-death, it is strictly categorized as DCD IV. In DCD IV, if the life-sustaining treatment is stopped due to unsuccessful brain death determination, it becomes DCD III process. All potential recipients were already arranged through KONOS. We can actively perform DCD after WLST in Korea with the setup of laws and systems for DCD.

In Korea, 2‐4% of brain‐dead organ donations are from donors <16 years of age. We aimed to identify the current status of and challenges in pediatric organ donation from brain‐dead donors in Korea. We performed a retrospective analysis using data from KONOS between January 1, 2013, and December 31, 2017. Our research identified 107 pediatric donors aged <16 years, representing 4.4% of all donors in Korea between 2013 and 2017. The consent rate was higher in PDs than in adult donors (47.0% vs 44.9%). The most common cause of brain death in PDs was hypoxia (28.0%), followed by brain tumor and trauma, whereas that in ADs was brain hemorrhage/stroke (42.4%), followed by trauma and hypoxia (P < .001). In both groups, the kidney (PDs vs ADs: 75.7% vs 88.5%), liver (58.9% vs 46.2%), and heart (32.7% vs 29.7%) were the organs most commonly transplanted. However, pancreatic (PDs vs ADs: 30.0% vs 11.7%, P < .001) and small bowel transplantations (4.7% vs 0.2%, P < .001) were more common in PDs, whereas lung (7.5% vs 14.5%, P = .046) and corneal transplantations (14.0% vs 36.2%) were more common in ADs. Only a small proportion of organ donations in Korea are from PDs, but this rate has been maintained. Given the current status of brain‐dead pediatric organ donation, a more active approach is required to bring about improvement.

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