Donation after circulatory death: current practices, ongoing challenges, and potential improvements.

Area of Science:

• Transplantation Medicine
• Organ Donation
• Nephrology

Background:

• Organ donation after circulatory death (DCD) is a globally recognized practice, yet faces challenges impacting organ utilization.
• While donor candidacy criteria are generally agreed upon, DCD practices vary, leading to limitations in organ perfusion and increased ischemic injury.
• Existing DCD protocols often result in higher rates of graft nonfunction, delayed function, and discard compared to donation after brain death.

Purpose of the Study:

• To review current DCD practices, identify associated problems and challenges.
• To explore clinical strategies for improving DCD organ utilization and outcomes.
• To assess the potential of emerging technologies and approaches in DCD transplantation.

Main Methods:

• Comprehensive review of current DCD practices and literature.
• Analysis of factors limiting DCD organ utilization, including ischemia and reperfusion injury.
• Evaluation of existing and novel clinical strategies for DCD organ procurement and preservation.

Main Results:

• DCD kidneys show comparable long-term function to brain death kidneys but higher rates of initial complications.
• Extra-renal DCD organs are less utilized due to concerns over ischemic injury and lack of supportive therapies.
• Emerging techniques like machine perfusion and normothermic regional perfusion show promise in mitigating ischemic injury and increasing organ viability.

Conclusions:

• Despite challenges, DCD offers a significant organ pool, with ongoing research focused on improving organ quality and utilization.
• Advancements in preservation techniques and strategies to minimize ischemic injury are key to enhancing DCD transplantation outcomes.
• Expanding DCD donor criteria and exploring innovative approaches like extended criteria donor utilization can further increase transplantable organs.