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Updated: Jun 21, 2026
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Initial experience with lung donation after cardiocirculatory death in Canada
Marcelo Cypel1, Masaaki Sato, Erkan Yildirim
1The Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada.
Insights
Organ donation after cardiac death (DCD) lungs show promising outcomes in Canada. This study found that DCD lung transplants have acceptable early and intermediate results, with 90% patient survival.
Area of Science:
- Transplantation immunology
- Thoracic surgery
- Organ donation research
Background:
- Organ donation after cardiac death (DCD) offers a potential solution to the critical shortage of donor lungs for transplantation.
- Limited data currently exist on the outcomes of DCD lung transplantation.
- This study aims to describe the early and intermediate outcomes of DCD lung transplantation in Canada.
Purpose of the Study:
- To evaluate the clinical outcomes of lung transplantation using organs from donors after cardiac death (DCD).
- To assess the utilization rates and post-transplant complications associated with DCD lung transplants.
- To report on patient survival and graft function following DCD lung transplantation.
Main Methods:
- Retrospective data collection from DCD lung transplant donors and recipients between June 2006 and December 2008.
- Analysis of the DCD lung protocol, donor characteristics, and post-transplant events including primary graft dysfunction (PGD), bronchial complications, acute rejection (AR), and bronchiolitis obliterans syndrome (BOS).
- Evaluation of patient survival, intensive care unit (ICU) stay, and hospital length of stay.
Main Results:
- The number of controlled DCD donors increased significantly from 2006 to 2008, with lung utilization rates rising to 27% in 2008.
- Nine DCD donors provided lungs for 10 recipients, with 0% 30-day mortality and only one case of severe PGD requiring ECMO.
- At a median follow-up of 270 days, 90% of patients survived with good graft function; one late death occurred due to sepsis.
Conclusions:
- Controlled DCD lung transplantation in Canada has shown a steady increase since 2006.
- The utilization of DCD lungs for transplantation is associated with very acceptable early and intermediate clinical outcomes.
- DCD lung transplantation represents a viable strategy to expand the donor lung pool and improve transplant rates.
Background:
Organ donation after cardiac death (DCD) has the potential to alleviate some of the shortage of suitable lungs for transplantation. Only limited data describe outcomes after DCD lung transplantation. This study describes the early and intermediate outcomes after DCD lung transplantation in Canada.
Methods:
Data were collected from donors and recipients involved in DCD lung transplantations between June 2006 and December 2008. Described are the lung DCD protocol, donor characteristics, and the occurrence of post-transplant events including primary graft dysfunction (PGD), bronchial complications, acute rejection (AR), bronchiolitis obliterans syndrome (BOS), and survival.
Results:
Successful multiorgan controlled DCD increased from 4 donors in 2006 to 26 in 2008. Utilization rates of lungs among DCD donors were 0% in 2006, 11% in 2007, and 27% in 2008. The lung transplant team evaluated 13 DCD donors on site, and lungs from 9 donors were ultimately used for 10 recipients. The 30-day mortality was 0%. Severe PGD requiring extracorporeal membrane oxygenation occurred in 1 patient. Median intensive care unit stay was 3.5 days (range, 2-21 days). Hospital stay was 25 days (range, 9-47 days). AR occurred in 2 patients. No early BOS has developed. Nine (90%) patients are alive at a median of 270 days (range, 47-798 days) with good performance status and lung function. One patient died of sepsis 17 months after transplantation.
Conclusion:
DCD has steadily increased in Canada since 2006. The use of controlled DCD lungs for transplantation is associated with very acceptable early and intermediate clinical outcomes.
