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

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Organ donation after circulatory death (DCD) offers a vital source of organs, though challenges like ischemia impact utilization. Strategies to mitigate injury and improve organ recovery are crucial for expanding DCD transplantation.

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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.