The History of DCD Liver Transplant
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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.
KeywordsDonation after cardiac death Liver transplantation Uniform Determination of Death Act History First liver transplant
- 12.A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205:337–40.Google Scholar
- 16.Dempsey D. Transplants are common; now it’s the organs that have become rare. N Y Times Mag. 1974;13 Oct 1974:Unknown.Google Scholar
- 17.Potts JT Jr, Herdman R. Non-heart-beating organ transplantation: medical and ethical issues in procurement. Washington (DC): National Academies Press (US); 1997.Google Scholar
- 23.Institute of Medicine Committee on Non-Heart-Beating Transplantation IITS, Ethical Basis for P and Protocols. Non-heart-beating organ transplantation: practice and protocols. Washington (DC): National Academies Press (US). Copyright 2000 by the National Academy of Sciences. All rights reserved.; 2000.Google Scholar
- 25.Recommendations for nonheart-beating organ donation. A position paper by the Ethics Committee, American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med. 2001;29:1826–31.Google Scholar
- 26.Bernat JL, D’Alessandro AM, Port FK, Bleck TP, Heard SO, Medina J, Rosenbaum SH, Devita MA, Gaston RS, Merion RM, Barr ML, Marks WH, Nathan H, O’Connor K, Rudow DL, Leichtman AB, Schwab P, Ascher NL, Metzger RA, Mc Bride V, Graham W, Wagner D, Warren J, Delmonico FL. Report of a National Conference on Donation after cardiac death. Am J Transplant. 2006;6:281–91.CrossRefGoogle Scholar
- 29.Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, Shames BD, Becker YT, Odorico JS, Knechtle SJ, Sollinger HW, Kalayoglu M, D’Alessandro AM. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg. 2005;242:724–31.CrossRefGoogle Scholar
- 33.Foley DP, Fernandez LA, Leverson G, Anderson M, Mezrich J, Sollinger HW, D’Alessandro A. Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcomes from a single center. Ann Surg. 2011;253:817–25.CrossRefGoogle Scholar
- 34.Hashimoto K, Eghtesad B, Gunasekaran G, Fujiki M, Uso TD, Quintini C, Aucejo FN, Kelly DM, Winans CG, Vogt DP, Parker BM, Irefin SA, Miller CM, Fung JJ. Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors. Am J Transplant. 2010;10:2665–72.CrossRefGoogle Scholar
- 37.Watson CJE, Kosmoliaptsis V, Randle LV, Gimson AE, Brais R, Klinck JR, Hamed M, Tsyben A, Butler AJ. Normothermic perfusion in the assessment and preservation of declined livers before transplantation: hyperoxia and vasoplegia-important lessons from the first 12 cases. Transplantation. 2017;101:1084–98.CrossRefGoogle Scholar
- 38.van Leeuwen OB, de Vries Y, Fujiyoshi M, Nijsten MWN, Ubbink R, Pelgrim GJ, Werner MJM, Reyntjens K, van den Berg AP, de Boer MT, de Kleine RHJ, Lisman T, de Meijer VE, Porte RJ. Transplantation of high-risk donor livers after ex situ resuscitation and assessment using combined hypo- and normothermic machine perfusion: a prospective clinical trial. Ann Surg. 2019.Google Scholar