Evaluation of Liver Graft Donation After Euthanasia

Abstract

The option of donating organs after euthanasia is not well known. Assessment of the results of organ transplants with grafts donated after euthanasia is essential to justify the use of this type of organ donation.OBJECTIVES To assess the outcomes of liver transplants (LTs) with grafts donated after euthanasia (donation after circulatory death type V [DCD-V]), and to compare them with the results of the more commonly performed LTs with grafts from donors with a circulatory arrest after the withdrawal of life-supporting treatment (type III [DCD-III]). DESIGN, SETTING, AND PARTICIPANTSThis retrospective multicenter cohort study analyzed medical records and LT data for most transplant centers in the Netherlands and Belgium. All LTs with DCD-V grafts performed from the start of the donation after euthanasia program (September 2012 for the Netherlands, and January 2005 for Belgium) through July 1, 2018, were included in the analysis. A comparative cohort of patients who received DCD-III grafts was also analyzed. All patients in both cohorts were followed up for at least 1 year. Data analysis was performed from September 2019 to December 2019.EXPOSURES Liver transplant with either a DCD-V graft or DCD-III graft.MAIN OUTCOMES AND MEASURES Primary outcomes were recipient and graft survival rates at years 1, 3, and 5 after the LT. Secondary outcomes included postoperative complications (early allograft dysfunction, hepatic artery thrombosis, and nonanastomotic biliary strictures) within the first year after the LT. RESULTS Among the cohort of 47 LTs with DCD-V grafts, 25 organ donors (53%) were women and the median (interquartile range [IQR]) age was 51 (44-59) years. Among the cohort of 542 LTs with DCD-III grafts, 335 organ donors (62%) were men and the median (IQR) age was 49 (37-57) years. Median (IQR) follow-up was 3.8 (2.1-6.3) years. In the DCD-V cohort, 30 recipients (64%) were men, and the median (IQR) age was 56 (48-64) years. Recipient survival in the DCD-V cohort was 87% at 1 year, 73% at 3 years, and 66% at 5 years after LT. Graft survival among recipients was 74% at 1 year, 61% at 3 years, and 57% at 5 years after LT. These survival rates did not differ statistically significantly from those in the DCD-III cohort. Incidence of postoperative complications did not differ between the groups. For example, the occurrence of early allograft dysfunction after the LT was found to be 13 (31%) in the DCD-V cohort and 219 (45%) in the DCD-III cohort. The occurrence of nonanastomotic biliary strictures after the LT was found to be 7 (15%) in the DCD-V cohort and 83 (15%) in the DCD-III cohort. CONCLUSIONS AND RELEVANCEThe findings of this cohort study suggest that LTs with DCD-V grafts yield similar outcomes as LTs with DCD-III grafts; therefore, grafts donated after euthanasia may be a justifiable option for increasing the organ donor pool. However, grafts from these donations should be considered high-risk grafts that require an optimal donor selection process and logistics.

HO-1/BMMSC perfusion using a normothermic machine perfusion system reduces the acute rejection of DCD liver transplantation by regulating NKT cell co-inhibitory receptors in rats

“…Liver transplantation (LT) is the most effective way of treating end-stage liver disease (e.g., cirrhosis, liver cancer) [ 1 ]. Because of donor shortages, marginal donors are used for transplantation [ 2 , 3 ], including donation after cardiac death (DCD) livers [ 4 , 5 ]. Static cold storage (SCS) methods are poor for preserving DCD livers, leading to increased probability of postoperative complications and affecting the prognosis of transplantation [ 4 , 6 ].…”

Ex Situ Perfusion of Hearts Donated After Euthanasia: A Promising Contribution to Heart Transplantation

“… 8 Donation following euthanasia has the potential to become an important source of donor hearts. Contrary to published results on kidneys, lungs, and livers donated following euthanasia, 9 - 11 literature on the function of hearts donated following euthanasia is still nonexistent. In the DCD-V donor pool, the agonal phase is usually very short and predictable, as the donor often dies quickly following administration of the euthanasia drugs.…”

“…Our study is in line with the finding of Van Reeven et al that in DCD-V donors, the agonal phase is very short and predictable. 9 Therefore, the donated hearts will be procured rapidly, which will increase the number of effective donation procedures as compared with DCD-III procedures. Approximately 5%–10% of all patients requesting euthanasia might be eligible to donate their organs.…”

Utility of Islet Cell Preparations From Donor Pancreases After Euthanasia

“…In a number of countries, including Belgium, Luxemburg, The Netherlands, and some regions in Canada, a legal and ethical framework allows organ and tissue donation after euthanasia 5 , 6 , thus providing the possibility to increase the organ donor pool 7 . These donors are rarely hospitalized or admitted to the intensive care unit and have not underwent an acute neurological insult with its associated cytokine storm, nor episodes of cardiac dysfunction and decreased organ perfusion 8 – 11 . Despite these benefits, organ procurement can only be performed after cessation of circulation, leading to exposure to an initial episode of warm ischemia time (WIT), increasing the risk for organ dysfunction.…”