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Trauma and donation after circulatory death: a case series from a major trauma center
Alessandro Circelli1, Etrusca Brogi2, Emiliano Gamberini1
1Department of Intensive Care Anesthesia and Trauma Division, Cesena, Italy.
Insights
Donation after circulatory death (DCD) organ donation can be expanded by using trauma patients. Normothermic regional perfusion (NRP) successfully preserved organs from trauma donors, enabling successful transplantation and improving graft survival.
Area of Science:
- Transplantation Medicine
- Trauma Surgery
- Organ Preservation
Background:
- Donation after circulatory death (DCD) transplantation is limited despite good outcomes.
- Warm ischemia poses a significant barrier to DCD graft survival.
- DCD in trauma patients could increase organ availability.
Purpose of the Study:
- To evaluate the feasibility of DCD organ retrieval and transplantation in trauma patients.
- To assess the efficacy of normothermic regional perfusion (NRP) in preserving organs from trauma donors.
- To explore the potential of DCD from trauma patients to expand the donor pool.
Main Methods:
- Five trauma patients meeting DCD criteria were identified.
- Normothermic regional perfusion (NRP) was initiated following circulatory death confirmation.
- Continuous organ-specific supportive treatment was administered.
- Organs were retrieved and transplanted successfully.
Main Results:
- Successful organ retrieval and transplantation were achieved in all five cases.
- NRP effectively preserved organs, mitigating warm ischemia damage.
- Trauma donors, despite severe injuries, provided viable organs for transplantation.
- The approach facilitated successful transplantation outcomes.
Conclusions:
- DCD organ donation from trauma patients is a viable strategy to increase organ availability.
- NRP is an effective technique for organ preservation in DCD from trauma donors.
- This approach holds significant potential for expanding transplantation programs.
Abstract:
Even with encouraging recipient outcomes, transplantation using donation after circulatory death (DCD) is still limited. A major barrier to this type of transplantation is the consequences of warm ischemia on graft survival; however, preservation techniques may reduce the consequences of cardiac arrest and provide better organ conservation. Furthermore, DCD in trauma patients could further expand organ donation. We present five cases in which organs were retrieved and transplanted successfully using normothermic regional perfusion (NRP) in trauma patients. Prompt critical care support and surgical treatment allowed us to overcome the acute phase. Unfortunately, owing to the severity of their injuries, all of the donors died. However, the advanced and continuous organ-specific supportive treatment allowed the maintenance of general clinical stability and organ preservation. Consequently, it was possible to retrieve and transplant the donors' organs. Death was ascertained in accordance with cardio-circulatory criteria, which was followed by NRP. We consider that DCD in trauma patients may represent an important source of organs.
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