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Updated: May 26, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Donation after circulatory death
A R Manara1, P G Murphy, G O'Callaghan
1The Intensive Care Unit, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK. alex.manara@nbt.nhs.uk
Insights
Donation after circulatory death (DCD) is crucial for organ transplantation due to organ shortages. DCD involves organ retrieval after death is confirmed by circulatory criteria, expanding beyond kidneys to organs like the liver and lungs.
Area of Science:
- Medical Science
- Transplantation Medicine
- Bioethics
Background:
- The persistent shortage of organs for transplantation necessitates exploring alternative donation models.
- Donation after circulatory death (DCD) is re-emerging as a vital source for organs, including kidneys, liver, pancreas, and lungs.
- DCD differs significantly from the standard donation after brain death model.
Purpose of the Study:
- To discuss the challenges and ethical considerations in implementing DCD programs.
- To highlight the growing professional consensus on the ethical and legal justification of DCD interventions.
- To explore the integration of DCD into routine end-of-life care.
Main Methods:
- Review of current practices and ethical frameworks for DCD.
- Analysis of the challenges in identifying suitable DCD donors and managing warm ischaemia.
- Examination of professional, ethical, and legal aspects of DCD.
Main Results:
- DCD is increasingly utilized for various organs beyond kidneys, despite challenges like warm ischaemia.
- Professional consensus is growing regarding the ethical and legal acceptability of DCD interventions.
- In some nations, DCD constitutes a significant portion of deceased organ donors, becoming part of end-of-life care.
Conclusions:
- DCD is a critical strategy to address organ shortages for transplantation.
- Addressing challenges in donor identification and ischaemia management is key to successful DCD programs.
- The integration of DCD into end-of-life care signifies a shift towards routine organ donation practices.
Abstract:
Donation after circulatory death (DCD) describes the retrieval of organs for the purposes of transplantation that follows death confirmed using circulatory criteria. The persisting shortfall in the availability of organs for transplantation has prompted many countries to re-introduce DCD schemes not only for kidney retrieval but increasingly for other organs with a lower tolerance for warm ischaemia such as the liver, pancreas, and lungs. DCD contrasts in many important respects to the current standard model for deceased donation, namely donation after brain death. The challenge in the practice of DCD includes how to identify patients as suitable potential DCD donors, how to support and maintain the trust of bereaved families, and how to manage the consequences of warm ischaemia in a fashion that is professionally, ethically, and legally acceptable. Many of the concerns about the practice of both controlled and uncontrolled DCD are being addressed by increasing professional consensus on the ethical and legal justification for many of the interventions necessary to facilitate DCD. In some countries, DCD after the withdrawal of active treatment accounts for a substantial proportion of deceased organ donors overall. Where this occurs, there is an increased acceptance that organ and tissue donation should be considered a routine part of end-of-life care in both intensive care unit and emergency department.
