Background. This study aims to verify the condition of recipients of solid organs from donors with central nervous system (CNS) tumors and determine the risk of disease transmission due to transplantation. Methods. Twenty-eight brain-dead organ donors with CNS tumors and 91 recipients who received solid organs from January 1, 2005, to December 31, 2014 in Korea were investigated using the Korean Network of Organ Sharing data. Results. Of the 36 recipients of organs from the 11 donors whose pathological results were not verified, 4 developed the following tumors: renal cell carcinoma, carcinoma in situ of the cervix uteri, B-cell lymphoma, and colon cancer. Among 51 recipients from 17 donors with CNS tumor, no recipient had the same tumor as the donors. Six were classified as high-risk donors according to the World Health Organization classification, and 14 recipients from these donors did not develop tumor after transplantation. The remaining 11 donors were classified as low-risk donors according to the World Health Organization classification but as high-risk donors according to the Malignancy Subcommittee of the Disease Transmission Advisory Committee of the Organ Procurement and Transplantation Network/United Network for Organ Sharing. Of the 37 recipients, 3 had recurring hepatocellular carcinoma with lung and bone metastases, thyroid cancer, and Kaposi’s sarcoma after transplantation. Conclusions. The risk of disease transmission due to organ transplantation from donors with CNS tumors was very low. Thus, organ donation from such donors should be promoted actively to expand the donor range.

BackgroundThis retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years.MethodsData of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family.ResultsFrom January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead.ConclusionThe rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.

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.

The “Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life” was enacted in February 2018 in Korea. Therefore, we suggest a Korean guideline for organ donation after circulatory death (DCD) category III after the withdrawal of life-sustaining treatment (WLST). Implementation of WLST includes stopping ventilation, extubation, discontinuation of inotropics and vasoconstrictors, cessation of continuous renal replacement therapy, and cessation of extracorporeal membrane oxygenation. Medical staff involved in organ procurement or transplantation surgery cannot participate in the WLST process. Following cardiac arrest, 5 minutes of “no touch time” should pass, after which circulatory death can be declared. The procurement team can enter the room after the declaration of death. The final procurement decision is made after the surgeon visually checks the organ condition. DCD category III activation in Korea will help increase organ donation and reduce the demand-supply mismatch of organ transplantation.

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.