Current situation of donation after circulatory death in European countries

Domínguez‐Gil, Beatriz; Haase‐Kromwijk, Bernadette; Leiden, H van; Neuberger, James; Coene, L. N. J. E. M.; Morel, Philippe; Antoine, Corinne; Muehlbacher, Ferdinand; Brezovský, P; Costa, Alessandro Nanni; Rozental, Rafail; Matesanz, Rafael

doi:10.1111/j.1432-2277.2011.01257.x

Cited by 256 publications

(156 citation statements)

References 34 publications

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“…11 This has been verified by the fact that most countries initiating DCD programs have observed a reduction in DBD procedures, but the application of DBD has remained stable in countries without DCD programs. 72 However, these findings contradict the UNOS data, which suggest that DCD activity has increased and supplemented overall transplant activity. 7 There are several possible explanations for this phenomenon.…”

Section: Important Issuescontrasting

confidence: 56%

Untitled

2015

Exp Clin Transplant

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There are increasing numbers of patients on liver transplant waiting lists, and there is a continuing organ shortage crisis. Therefore, more centers and organ procurement organizations are developing protocols for donation after cardiac death. However, the effect of donation after cardiac death allografts on overall patient survival remains controversial, with some centers reporting equivalent patient posttransplant survival but many others indicating increased rates of complications, retransplant, utilization of resources, and death. Several potential risk factors that predict graft loss and recipient complications have been identified. To improve patient outcomes and reduce dropouts, experimental strategies that target both donors and recipients at various phases of the transplant process have focused on attenuating ischemia-reperfusion injury and have achieved encouraging results. In the present article, our goal is to provide an overview of the current status of, and recent advances in, liver transplant from donation after cardiac death, to better understand the risks and potential benefits of donation after cardiac death liver transplant.

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Section: Important Issuescontrasting

confidence: 56%

Untitled

2015

Exp Clin Transplant

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“…This particular type of DCD implies an important logistical effort, both inside and outside of the hospital, and a smooth cooperation between the different stakeholders involved (29). Legal, ethical, and the aforementioned complexities have precluded many countries from embarking on this type of donation despite efforts to emulate this program in other realities (30). Even within Spain, because of the degree of sophistication required, the activity was initially limited to three Spanish cities-A Coruña, Barcelona, and Madrid.…”

Section: Nonstandard Risk Donorsmentioning

confidence: 99%

How Spain Reached 40 Deceased Organ Donors per Million Population

Matesanz

Domínguez‐Gil

Coll

et al. 2017

American Journal of Transplantation

197

112

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With 40 donors and more than 100 transplant procedures per million population in 2015, Spain holds a privileged position worldwide in providing transplant services to its patient population. The Spanish success derives from a specific organizational approach to ensure the systematic identification of opportunities for organ donation and their transition to actual donation and to promote public support for the donation of organs after death. The Spanish results are to be highlighted in the context of the dramatic decline in the incidence of brain death and the changes in end‐of‐life care practices in the country since the beginning of the century. This prompted the system to conceive the 40 donors per million population plan, with three specific objectives: (i) promoting the identification and early referral of possible organ donors from outside of the intensive care unit to consider elective non‐therapeutic intensive care and incorporate the option of organ donation into end‐of‐life care; (ii) facilitating the use of organs from expanded criteria and non–standard risk donors; and (iii) developing the framework for the practice of donation after circulatory death. This article describes the actions undertaken and their impact on donation and transplantation activities.

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“…Fifty-five percent of patients needed at least one session of hemodialysis (DGF) postoperatively [60] . Use of DCD whether controlled or uncontrolled is associated with high PNF and DGF but the long term outcome is satisfactory (Table 2) [7,19,61] . However, some reports showed no significant difference between DCD and DBD.…”

Section: Dgf and Primary Non Functionmentioning

confidence: 99%

“…Effect on DBD Dominguez-Gil et al [61] conducted a survey of 27 European countries to determine the level of DCD activity. Only 10 confirmed any DCD activity, the highest rates being described in Belgium, the Netherlands and the United Kingdom (mainly controlled); and France and Spain (mainly uncontrolled).…”

Section: Allocationmentioning

confidence: 99%

Kidney donation after cardiac death

Akoh¹

2012

WJN

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There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death (DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

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Current situation of donation after circulatory death in European countries

Cited by 256 publications

References 34 publications

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How Spain Reached 40 Deceased Organ Donors per Million Population

Kidney donation after cardiac death

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