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Organ donation after circulatory death: an update
Murray J Blackstock1, David C Ray
1aDepartment of Anaesthesia, Critical Care and Pain Medicine, Western General Hospital bDepartment of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary, Edinburgh, Scotland.
Insights
Organ donation faces a global shortage. Donation after circulatory death (DCD) has surged in the UK, increasing organ availability, particularly kidneys, though challenges remain.
Area of Science:
- Transplantation Medicine
- Organ Donation Research
Background:
- Global organ transplant waiting lists highlight a critical shortage of available organs.
- Donation after circulatory death (DCD) is a key strategy to increase organ donor numbers and improve transplant rates.
Purpose of the Study:
- To review the trends and outcomes of organ donation after circulatory death (DCD) in the UK.
- To examine the implications and challenges associated with the rise of DCD donation.
Main Methods:
- Analysis of DCD donor numbers in the UK from 2001 to 2010.
- Review of organ types transplanted from DCD donors.
- Discussion of ethical and clinical considerations related to DCD.
Main Results:
- DCD donors in the UK saw an 808% increase between 2001 and 2010.
- Kidneys are the most commonly transplanted organs from DCD donors, with growing experience in liver, lung, and pancreas.
- Transplantation outcomes from DCD donors are generally encouraging, especially for kidney transplants.
Conclusions:
- The significant increase in DCD donation is vital for addressing organ shortages.
- The rise of DCD necessitates careful consideration of associated ethical issues, including the dead donor rule and clinical conflicts of interest.
- Continued research and standardized practices are needed to optimize DCD donation and transplantation globally.
Abstract:
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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