Donation after circulatory death and its expansion in Spain

Abstract

DCD has been successfully developed in Spain following a streamlined process. nRP may become a standard in DCD, although further evidence on the benefits of this technology is eagerly awaited.

Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death

“…10,11 In terms of the outcomes obtained using organs procured by this process, while excellent long-term kidney graft survival has been reported from uDCD procedures, 12 liver transplant outcomes have been mixed, 13 and there is only limited but promising experience in uDCD lung transplantation. 8,17 If the lungs are also preserved, lung warm ischemic time (WIT) is significantly increased, because abdominal grafts must initially be preserved using abdominal normothermic recirculation with extracorporeal membrane oxygenation (ECMO) devices or cold in situ perfusion; once this procedure has been completed, the lungs can then be preserved. 8,17 If the lungs are also preserved, lung warm ischemic time (WIT) is significantly increased, because abdominal grafts must initially be preserved using abdominal normothermic recirculation with extracorporeal membrane oxygenation (ECMO) devices or cold in situ perfusion; once this procedure has been completed, the lungs can then be preserved.…”

“…14 16 Nevertheless, most uDCD programs have focused on abdominal grafts, mainly kidneys, only occasionally considering lungs for transplantation as well. 14,15,17 Although the results of early experiences with uDCD lung transplantation appeared to be inferior to DBD transplants, 14,15 due to the higher rates of graft dysfunction compared to donors with brain death, 18 recent studies conducted in Spain (which has the largest worldwide experience in lung transplantation from uDCD donors) have shown no differences in survival rates compared to transplants from DBD donors. 14,15,17 Although the results of early experiences with uDCD lung transplantation appeared to be inferior to DBD transplants, 14,15 due to the higher rates of graft dysfunction compared to donors with brain death, 18 recent studies conducted in Spain (which has the largest worldwide experience in lung transplantation from uDCD donors) have shown no differences in survival rates compared to transplants from DBD donors.…”

“…8,17 If the lungs are also preserved, lung warm ischemic time (WIT) is significantly increased, because abdominal grafts must initially be preserved using abdominal normothermic recirculation with extracorporeal membrane oxygenation (ECMO) devices or cold in situ perfusion; once this procedure has been completed, the lungs can then be preserved. 17,19 This experience has recently been replicated in Italy and the United States. 17,19 This experience has recently been replicated in Italy and the United States.…”

“…programs recommend a WIT <150 minutes and a maximum preservation time <240 minutes 9,17. Our protocol initially shortened these limits up to 120 minutes and 180 minutes, respectively.…”

The unique moral permissibility of uncontrolled lung donation after circulatory death

“…Studies have examined the resuscitation duration in context of auto-resuscitation-when a heart stops beating spontaneously and restarts-and have shown cases of auto-resuscitation up to 10 minutes from TOR in adults and 2 minutes in children. 12,22 Previous uDCDD programs in the United States have relied on registered donors to avoid the challenge of obtaining authorization quickly enough for organ preservation, and have largely failed because of insufficient enrollment. 29 Others follow a 5-minute no-touch period.…”