Developing a DCD Liver Transplant Program
- 12 Downloads
With the significant risk of waitlist mortality in the end-stage liver disease population, donation after circulatory death (DCD) liver transplantation remains an important but underutilized source of deceased donor organs in many parts of the world. Committing to develop a DCD liver transplant program in many ways requires a reinvention of the liver transplant program itself. It requires strong but collaborative leadership, identification of program demand for DCD livers, and broad stakeholder engagement inside the hospital with transplant and non-transplant personnel. Additionally, protocols must be developed for recipient selection, donor acceptance criteria, and clinical management. A strong performance monitoring plan is necessary. Understanding the key principles discussed here may help DCD liver transplant programs provide wider access to liver transplantation to clinically vulnerable populations whose mortality risk is not well represented by their MELD score. In this chapter, we aim to review key principles that programs should consider in implementing a DCD liver transplant program. These key principles include: leadership and mentorship, team development and engagement, careful recipient selection, utilization of data-driven protocols, relationship management with organ procurement organizations and donor hospitals, and the use of clinical quality improvement techniques to push stepwise program maturation.
KeywordsDevelopment Starting DCD Mentorship Liver Transplant
- 1.Bohorquez H, Seal JB, Cohen AJ, Kressel A, Bugeaud E, Bruce DS, Carmody IC, Reichman TW, Battula N, Alsaggaf M, Therapondos G, Bzowej N, Tyson G, Joshi S, Nicolau-Raducu R, Girgrah N, Loss GE. Safety and outcomes in 100 consecutive donation after circulatory death liver transplants using a protocol that includes thrombolytic therapy. Am J Transplant. 2017;17(8):2155–64.CrossRefGoogle Scholar
- 5.DeOliveira ML, Jassem W, Valente R, Khorsandi SE, Santori G, Prachalias A, Srinivasan P, Rela M, Heaton N. Biliary complications after liver transplantation using grafts from donors after cardiac death: results from a matched control study in a single large volume center. Ann Surg. 2011;254(5):716–22; discussion 722–3CrossRefGoogle Scholar
- 7.Kollmann D, Sapisochin G, Goldaracena N, Hansen BE, Rajakumar R, Selzner N, Bhat M, McCluskey S, Cattral MS, Greig PD, Lilly L, McGilvray ID, Ghanekar A, Grant DR, Selzner M. Expanding the donor pool: donation after circulatory death and living liver donation do not compromise the results of liver transplantation. Liver Transpl. 2018;24(6):779–89.CrossRefGoogle Scholar