Donation after cardiac death: where, when, and how?

Area of Science:

• Transplantation immunology
• Organ donation
• Surgical innovation

Background:

• Organ donor shortages necessitate the use of marginal grafts.
• Traditional donation methods have not reduced waiting list mortality.
• Donation after brain death (DBD) became primary after 1968, shifting from Donation after Cardiac Death (DCD).

Purpose of the Study:

• To review the evolution and current status of DCD in organ transplantation.
• To highlight the potential of DCD to expand the organ donor pool.
• To discuss advancements in DCD protocols and their impact on graft outcomes.

Main Methods:

• Review of historical data and international guidelines on DCD.
• Analysis of outcomes from controlled (CDCD) and uncontrolled (UDCD) DCD programs.
• Examination of recent technological advancements in organ preservation.

Main Results:

• DCD, categorized into CDCD and UDCD, constitutes 10%-20% of donors in many countries.
• Despite initial challenges, optimized protocols achieve 1- and 3-year graft survivals of 80% and 70%, with primary nonfunction and ischemic-type biliary lesion rates below 3%.
• Legal frameworks influence the implementation of UDCD and CDCD.

Conclusions:

• DCD represents a significant opportunity to increase organ availability for adult and pediatric recipients.
• Advancements in perfusion technology promise further optimization of DCD grafts.
• DCD is crucial for addressing the ongoing organ shortage crisis.