Variability in Donation After Cardiac Death Protocols: A National Survey

Fugate, Jennifer E.; Stadtler, Maria; Rabinstein, Alejandro A.; Wijdicks, Eelco F. M.

doi:10.1097/tp.0b013e318204ee96

Cited by 37 publications

(25 citation statements)

References 6 publications

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“…The sample was limited to organs procured within a single organ procurement organization service area, and thus our findings may have limited generalizability. An analysis of this kind is inherently limited by variations in practice relating to determination of death (25). These practices are neither standardized across practitioners nor documented, limiting our ability to assess their clinical importance.…”

Section: Discussionmentioning

confidence: 99%

“…Beyond physiological heterogeneity, the current investigation's models also included variability in the process of organ procurement. DWI encompasses not only donor physiology but also variability in practices relating to determination of cardiopulmonary death, stand-down time to monitor for spontaneous autoresuscitation and time necessary to initiate procurement (25). Hemodynamic measures truncated at cross-clamp incorporate both physiological and practicebased characteristics of DWI.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Donor Hemodynamics as a Predictor of Outcomes After Kidney Transplantation From Donors After Cardiac Death

Allen

Billig

Reese

et al. 2016

American Journal of Transplantation

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Donor Hemodynamics as a Predictor of Outcomes After Kidney Transplantation From Donors After Cardiac Death

Allen

Billig

Reese

et al. 2016

American Journal of Transplantation

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“…Nevertheless, variations in exclusion and inclusion criteria, the venue for WLST, the criteria for DCD, the definition of circulatory arrest, the length of mandatory observation waiting time, and the separation of roles of transplant physicians and clinicians responsible for WLST and declaring death persist. Standard DCD practices would achieve maximal DCD organ procurement and preserve optimal end-of-life care, public trust, and professional integrity (18,19).…”

Section: Differences In Dcd Protocolsmentioning

confidence: 99%

Donation After Circulatory Death

2014

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Organ donation after circulatory death (DCD) has been endorsed by the World Health Organization and is practiced worldwide. This overview examines current DCD practices, identifies problems and challenges, and suggests clinical strategies for possible improvement. Although there is uniform agreement on DCD donor candidacy (ventilator-dependent individuals with nonrecoverable or irreversible neurologic injury not meeting brain death criteria), there are variations in all aspects of DCD practice. Utilization of DCD organs is limited by hypoxia, hypotension, reduced--then absent--organ perfusion, and ischemia/reperfusion syndrome. Nevertheless, DCD kidneys exhibit comparable function and survival to donors with brain death kidneys, although they have higher rates of primary graft nonfunction, delayed graft function, discard, and retrieval associated injury. Concern over ischemic organ injury underscores the reluctance to recover extrarenal DCD organs since lack of medical therapy to support inadequate allograft function limits their acceptability. Nevertheless, limited results with DCD pancreas, liver, and lung allografts (but not heart) are now approaching that of donors with brain death organs. Pretransplant machine perfusion of DCD kidneys (vs. static storage) may reduce delayed graft function but has no effect on long-term organ function and survival. Normothermic regional perfusion used during DCD abdominal organ retrieval may reduce ischemic organ injury and increase the number of usable organs, although critical confirmative studies have yet to be done. Minor increases in usable DCD kidneys could accrue from increased use of pediatric DCD kidneys and from selective use of DCD/ECD kidneys, whereas a modest increase could result through utilization of donors declared dead beyond 1 hr from withdrawal of life support therapy. A significant increase in transplantable kidneys could be achieved by extension of the concept of living kidney donation in relation to imminent death of potential DCD donors. Progress in research to identify, prevent, and repair DCD-associated organ retrieval injury should improve utilization of DCD organs. Recent results using ex situ pretransplant organ perfusion of DCD organs has been encouraging in this regard.

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“…During this time, the interests of the patient and the wishes of the family are paramount; any family objection should cause the donation process to stop [13]. A survey comparing 64 protocols in 16 US states found that 59% of withdrawals occurred in the operating theatre and the time from asystole to confirming death ranged from 2 to 5 min [14]. A survey comparing 64 protocols in 16 US states found that 59% of withdrawals occurred in the operating theatre and the time from asystole to confirming death ranged from 2 to 5 min [14].…”

Section: Origins Of Donation After Circulatory Deathmentioning

confidence: 99%

Organ donation after circulatory death

Blackstock

Ray²

2014

European Journal of Emergency Medicine

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There is an ongoing shortfall of organs for donation in the UK and worldwide. Strategies including donation after circulatory death (DCD), living donation and better identification of potential donors are attempting to increase the number of donors and donated organs. The number of DCD donors in the UK increased by 808% from 37 to 336 between 2001 and 2010 and this is continuing to increase. The most common organs donated from DCD donors are the kidneys, but there is increasing experience of liver, lung and pancreas transplantation. The process of DCD varies between different countries and institutions. The outcome of DCD transplantation has been largely encouraging, particularly for kidneys. The increase in DCD has led to an appraisal of issues that may arise during the donation process; these include the Lazarus phenomenon, the dead donor rule, perimortem interventions, public opinion and conflict of interest for clinicians.

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Variability in Donation After Cardiac Death Protocols: A National Survey

Cited by 37 publications

References 6 publications

Donor Hemodynamics as a Predictor of Outcomes After Kidney Transplantation From Donors After Cardiac Death

Donor Hemodynamics as a Predictor of Outcomes After Kidney Transplantation From Donors After Cardiac Death

Donation After Circulatory Death

Organ donation after circulatory death

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