The History of DCD Liver Transplant

  • Adam S. A. Gracon
  • David P. FoleyEmail author


The advent of donation after cardiac death (DCD) liver transplantation began with Dr. Thomas Starzl performing the first liver transplant in 1963. As transplantation evolved as an acceptable therapy for patients with end-stage liver disease, the definition of brain death emerged and was accepted. Subsequently, organs were recovered predominantly from brain-dead donors with DCD essentially abandoned in liver transplantation. With the growth of liver transplantation, the disparity between available donor organs and the number of recipients on the waitlist increased with an associated increase in waitlist mortality. This resulted in renewed interest in the use of DCD donor organs as a viable approach to expanding the donor pool. As DCD liver transplantation was reintroduced by several academic medical centers, other institutions remained reluctant based on ethical concerns. However, with a focus on the core principles of organ donation including the dead donor rule, as well as the establishment of a legal and regulatory framework, DCD expanded and was ultimately endorsed by the Institute of Medicine (IOM) in the late 1990s and the Joint Commission for the Accreditation of Hospitals Organization in the early 2000s.

Early outcomes in DCD liver transplantation not only provided proof of concept but also demonstrated inferiority to donation after brain death liver transplant. This included reduced patient and graft survival, as well as increased biliary complications. As a result, efforts shifted to identifying risk factors for graft loss, mitigating risk, and improving outcomes. More recently, research has focused on matching the right donor liver to the right recipient through the development of scoring systems to attain optimal outcomes. With this, outcomes of DCD liver transplantation have improved with DCD donors contributing livers for nearly 10% of liver transplants performed in the United States annually.


Donation after cardiac death Liver transplantation Uniform Determination of Death Act History First liver transplant 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Transplant SurgeryUniversity of WisconsinMadisonUSA
  2. 2.Department of TransplantationUniversity of Wisconsin School of Medicine & Public HealthMadisonUSA

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