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Derivation and Implementation of a Protocol in Israel for Organ Donation after Cardio-Circulatory Death
Jonathan Cohen1,2,3, Ruth Rahamimov4,5, Aaron Hoffman6
1Department of General Intensive Care, Rabin Medical Center (Beilinson Campus), Petah Tikvah, Israel.
Insights
Donation after cardio-circulatory death (DCCD) protocols were successfully implemented in Israel, yielding encouraging results for kidney transplantation. This program shows promise in increasing organ availability.
Area of Science:
- Transplantation Medicine
- Organ Donation
- Nephrology
Background:
- Renewed interest in expanding the organ donor pool through donation after cardio-circulatory death (DCCD), also known as non-heart beating donors (NHBDs).
- Need for established protocols to address the unique challenges of DCCD programs.
Purpose of the Study:
- To develop and implement a DCCD protocol in Israel.
- To report on the initial outcomes of the first six DCCD cases.
Main Methods:
- Protocol development involving medical, social, ethical, and logistical considerations.
- Pilot study focused on kidney retrieval across four medical centers.
- Obtaining consent from surrogate decision-makers for organ donation.
Main Results:
- Successful implementation of the DCCD protocol in four medical centers.
- Four out of six potential donors provided consent for organ donation.
- Four kidneys were successfully transplanted with normal graft function at 6-12 months.
Conclusions:
- The DCCD program in Israel was successfully implemented with encouraging initial results.
- Expansion of the DCCD program may help reduce the organ shortage.
- DCCD offers a viable strategy to increase organ availability for transplantation.
Background:
Strategies aimed at expanding the organ donor pool have been sought, which has resulted in renewed interest in donation after cardio-circulatory death (DCCD), also known as non-heart beating donors (NHBDs).
Objectives:
To describe the derivation and implementation of a protocol for DCCD in Israel and report on the results with the first six cases.
Methods:
After receiving approval from an extraordinary ethics committee, Ministry of Health, the steering committee of the National Transplant Center defined and reached consensus on the unique challenges presented by a DCCD program. These protocol included medical aspects (construction of a clinical pathway), social and ethical aspects (presentation of the protocol at a public gathering(, legal/ethical aspects (consent for organ preservation procedures being either implied if the donor had signed an organ donor card or received directly from a surrogate decision maker), and logistical aspects (pilot study confined to kidney retrieval and to four medical centers). Data regarding organ donors and recipients were recorded.
Results:
The protocol was implemented at four medical centers. Consent for organ donation was received from four of the six potential donors meeting criteria for inclusion, in all cases, from a surrogate decision maker. Of the eight kidneys retrieved, only four were suitable for transplantation, which was carried out successfully for four recipients. Graft function remained normal in all cases in 6-12 months follow-up.
Conclusions:
The DCCD program was successfully implemented and initial results are encouraging, suggesting that expansion of the program might further aid in decreasing the gap between needs and availability of organs.
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