Uncontrolled Donation After Circulatory Death: A Unique Opportunity

Area of Science:

• Organ transplantation
• Cardiovascular medicine
• Bioethics

Background:

• Uncontrolled donation after circulatory death (uDCD) has significant potential but limited global implementation.
• Logistical, ethical-legal barriers, and donor-recipient confidence impact uDCD program activity.
• Prolonged warm ischemia and ethical considerations (e.g., CPR termination, consent timing) are inherent to uDCD.

Purpose of the Study:

• To review the current status and challenges of uncontrolled donation after circulatory death (uDCD) programs.
• To discuss strategies for mitigating warm ischemia and addressing ethical concerns in uDCD.
• To evaluate the outcomes of organ transplantation from uDCD donors.

Main Methods:

• Review of existing literature on uDCD programs, procedures, and outcomes.
• Analysis of logistical, ethical, and legal barriers to uDCD implementation.
• Evaluation of organ transplant results, focusing on patient and graft survival rates.

Main Results:

• While primary nonfunction and delayed graft function are more common, uDCD kidney, liver, and lung transplants demonstrate acceptable patient and graft survival.
• Normothermic regional perfusion is crucial for optimizing outcomes in uDCD kidney and liver transplantation.
• The role of ex situ machine perfusion in uDCD is still under investigation.

Conclusions:

• uDCD represents a significant opportunity to expand transplantation access and increase organ donation.
• Careful donor and recipient selection, alongside techniques like normothermic regional perfusion, are key to successful uDCD transplantation.
• Further research is needed to clarify the role of machine perfusion in optimizing uDCD organ viability.