Categories of Donation After Cardiocirculatory Death

Detry, Olivier; Dinh, Hieu Le; Noterdaeme, Timothée; Roover, Arnaud De; Honoré, Pierre; Squifflet, Jean‐Paul; Meurisse, Michel

doi:10.1016/j.transproceed.2012.05.001

Cited by 79 publications

(65 citation statements)

References 71 publications

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“…DCD donors are characterized by the termination of ventilation and blood circulation before cold flushing of organs [3] . The idea to use DCD liver grafts was reintroduced in the 1990s after achieving success in kidney transplantation [3] .…”

Section: Characteristics Of Dcd Donorsmentioning

confidence: 99%

“…The idea to use DCD liver grafts was reintroduced in the 1990s after achieving success in kidney transplantation [3] . The use of grafts from DCD donors in the United States has exponentially increased from 0.95% in 2000 to 5% in 2010 (1 UNOS).…”

Section: Characteristics Of Dcd Donorsmentioning

confidence: 99%

“…In this group, the organ suffers from long WIT which is a detrimental factor in organ quality. In the controlled group, cardiac arrest is planned and it happens following withdrawal of ventilator in the operating room or intensive unit care [3,4] . It is generally accepted that DCD grafts have less energy stores and undergo more damage during the storage time [5] .…”

Section: Characteristics Of Dcd Donorsmentioning

confidence: 99%

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Potential approaches to improve the outcomes of donation after cardiac death liver grafts

Mahboub¹,

Bozorgzadeh²,

Martins³

2016

WJT

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There is a growing discrepancy between the supply and demand of livers for transplantation resulting in high mortality rates on the waiting list. One of the options to decrease the mortality on the waiting list is to optimize organs with inferior quality that otherwise would be discarded. Livers from donation after cardiac death (DCD) donors are frequently discarded because they are exposed to additional warm ischemia time, and this might lead to primary-non-function, delayed graft function, or severe biliary complications. In order to maximize the usage of DCD livers several new preservation approaches have been proposed. Here, we will review 3 innovative organ preservation methods: (1) different ex vivo perfusion techniques; (2) persufflation with oxygen; and (3) addition of thrombolytic therapy. Improvement of the quality of DCD liver grafts could increase the pool of liver graft's for transplantation, improve the outcomes, and decrease the mortality on the waiting list. Core tip: As the demand for more organs increases, the transplant community searches for new approaches to expand the pool of organs. Recently developed methods to improve the condition of donation after cardiac death (DCD) livers look promising. During the past decade, ex vivo machine perfusion method has demonstrated positive results and it is considered as a new potential preservation method for DCD organs. This paper provides an overview of the attempts to ameliorate the quality of DCD liver grafts and transplant outcomes by improving preservation techniques.Mahboub P, Bozorgzadeh A, Martins PN. Potential approaches to improve the outcomes of donation after cardiac death liver grafts. World J Transplant 2016; 6(2): 314320 Available from: URL:

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Section: Characteristics Of Dcd Donorsmentioning

confidence: 99%

Section: Characteristics Of Dcd Donorsmentioning

confidence: 99%

Section: Characteristics Of Dcd Donorsmentioning

confidence: 99%

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Potential approaches to improve the outcomes of donation after cardiac death liver grafts

Mahboub¹,

Bozorgzadeh²,

Martins³

2016

WJT

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“…1 In an article recently published in the Journal, Doyle and colleagues 2 reported the experience of the Washington University group in controlled DCD liver transplantation (LT). The authors have to be congratulated for their excellent results, with a 5-year DCD liver graft survival of 80% and a low rate of ischemic cholangiopathy, the most feared complication after DCD liver transplantation.…”

Section: Donor Age In Liver Transplantation: Donation After Circulatomentioning

confidence: 99%

Donor Age in Liver Transplantation: Donation after Circulatory Death

Detry¹

2015

Journal of the American College of Surgeons

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formed. Postural training is a foundational element of the protocol and continues at this stage.Finally, weeks 7 to 8 constitute complete mobilization of the upper extremity, with the goal of reaching full tension without pain or a feeling of stretching. Remaining limitations in soft tissue and joint mobility should be addressed. Therapeutic exercises include continued prolonged holds of postural muscles and plank exercises maintaining scapular neutral position with resistance when possible. Postural training in this stage involves full squats and mimicking work-related activities while maintaining neutral scapular posture.Regarding your second question, we do not regularly perform nerve conduction studies or MRI scans of brachial plexus for patients with NTOS. We prefer upper extremity venous and arteries duplex scans for these patients to assess for vascular compression in addition to neurogenic symptoms.Disclosure Information: Nothing to disclose. Donor Age in Liver Transplantation: Donation after Circulatory DeathOlivier Detry, MD, PhD Liege, BelgiumCompared with donation after brain death (DBD), donation after circulatory death (DCD) grafts are submitted to an additional procurement warm ischemia that might lead to graft failure. 1 In an article recently published in the Journal, Doyle and colleagues 2 reported the experience of the Washington University group in controlled DCD liver transplantation (LT). The authors have to be congratulated for their excellent results, with a 5-year DCD liver graft survival of 80% and a low rate of ischemic cholangiopathy, the most feared complication after DCD liver transplantation. However, this article deserves to be commented on and challenged.One of the main results of this paper is that DCD donor age greater than 40 years increases the risk of ischemic cholangiopathy.2 However, the data leading to this conclusion seem insufficient. First, there is a clear selection bias; threefourths of ischemic cholangiopathy cases occurred in the first part of the authors' experience and led to a change in policy to not permit DCD from donors older than 45 years, and importantly, a warm ischemic time of more than 20 minutes. Secondly, the statistics leading to this conclusion are quite weak. Nowhere in the article are the results of the DCD LT from donors younger and older than 40 years compared. Table 4 presented a p value < 0.006 when analyzing the relationship between DCD donor age and development of cholangiopathy, but only 4 DCD transplant recipients developed ischemic cholangiopathy, with at least 1 young donor aged 15 years. It is therefore difficult to understand this highly significant statistical difference in the relationship between donor age and ischemic cholangiopathy in such a small series.This issue is important because the actual deceased organ donor shortage is a clinical drama and in most Western countries, mean deceased donor age is increasing. 3 We recently reported our experience in DCD LT without clear donor age criteria, and the results of DCD LT from donors...

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“…Como siempre, la evaluación de cada caso en particular, considerando la mortalidad del paciente en espera, es fundamental para una correcta toma de decisiones 1,6,8 . En otros centros, ya existe amplia experiencia en la donación de órganos después de la muerte o paro cardiaco, pero este tema excede los objetivos de la presente revisión 9,10 .…”

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