Applicability and Results of Maastricht Type 2 Donation After Cardiac Death Liver Transplantation

Abstract

Maastricht type 2 donation after cardiac death (DCD) donors suffer sudden and unexpected cardiac arrest, typically outside the hospital; they have significant potential to expand the donor pool. Herein, we analyze the results of transplanted livers and all potential donors treated under our type 2 DCD protocol. Cardiac arrest was witnessed; potential donors arrived at the hospital after attempts at resuscitation had failed. Death was declared based on the absence of cardiorespiratory activity during a 5-min no-touch period. Femoral vessels were cannulated to establish normothermic extracorporeal membrane oxygenation, which was maintained until organ recovery. From April 2002 to December 2010, there were 400 potential donors; 34 liver transplants were performed (9%). Among recipients, median age, model for endstage liver disease and cold and reperfusion warm ischemic times were 55 years (49-60), 19 (14-21) and 380 (325-430) and 30 min (26-35), respectively. Overall, 236 (59%) and 130 (32%) livers were turned down due to absolute and relative contraindications to donate, respectively. One-year recipient and graft survivals were 82% and 70%, respectively (median follow-up 24 months). The applicability of type 2 DCD liver transplant was <10%; however, with better preservation technology and expanded transplant criteria, we may be able to improve this figure significantly.

Part 4: Advanced Life Support

“…For the important outcome of graft survival for 1 year, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non-heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (199 organs 357,358,360 ) or adult livers (60 organs 355,358,361 ). For the important outcome of graft survival for 5 years, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non-heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (177 organs 357,360 ) or adult livers (34 organs 355 ).…”

“…Two nonrandomized studies provided low-quality evidence that the mean number of organs procured from donors with ongoing CPR was 1.5 355 and 3.2.…”

“…other types of donors for adult kidneys (203 organs [357][358][359][360] ) or adult livers (64 organs 355,358,361,362 ). For the important outcome of graft survival for 1 year, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non-heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (199 organs 357,358,360 ) or adult livers (60 organs 355,358,361 ).…”

One donor, two types of preservation: First description of a donation after circulatory death donor with normothermic abdominal perfusion and simultaneous cold perfusion of lungs

“…Although ECMO-assisted organ procurement and transplantation have been reported in the literature 7 and have predominantly involved Maastricht category II donors, the advantages of applying this technique to controlled DCD donation from category III donors are manifold. Category II DCD organ transplantation has limited applicability, with only a handful of centers using this technique.…”

Experience of Virgen De Las Nieves University Hospital in Liver Transplantation Using Uncontrolled and Controlled Donors after Cardiac Death

“…Initially, this activity has developed in Spain by means of the uncontrolled DCD, or Maastricht type II donation. Controlled DCD or Maastricht type III donation was dropped because of ethical reasons in our country at first [3,4]. Recent changes in legal framework, in line with draft bill about the end-of-life rights, could favour the development of this type of donation [1].…”