Developing a DCD Liver Transplant Program

  • Amit K. MathurEmail author
  • Adyr A. Moss


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.


Development Starting DCD Mentorship Liver Transplant 


  1. 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
  2. 2.
    Chadha R, Croome K, Aniskevich S, Pai SL, Nguyen J, Burns J, Perry D, Taner C. Intraoperative events in liver transplantation using donation after cardiac death grafts. Liver Transpl. 2019;25(12):1833–40.CrossRefGoogle Scholar
  3. 3.
    Croome KP, Lee DD, Perry DK, Burns JM, Nguyen JH, Keaveny AP, Taner CB. Comparison of longterm outcomes and quality of life in recipients of donation after cardiac death liver grafts with a propensity-matched cohort. Liver Transpl. 2017;23(3):342–51.CrossRefGoogle Scholar
  4. 4.
    Croome KP, Lee DD, Keaveny AP, Taner CB. Noneligible donors as a strategy to decrease the organ shortage. Am J Transplant. 2017;17(6):1649–55.CrossRefGoogle Scholar
  5. 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
  6. 6.
    Giesbrandt KJ, Bulatao IG, Keaveny AP, Nguyen JH, Paz-Fumagalli R, Taner CB. Radiologic characterization of ischemic cholangiopathy in donation-after-cardiac-death liver transplants and correlation with clinical outcomes. AJR Am J Roentgenol. 2015;205(5):976–84.CrossRefGoogle Scholar
  7. 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
  8. 8.
    Laing RW, Scalera I, Isaac J, Mergental H, Mirza DF, Hodson J, Wilkin RJ, Perera MT, Muiesan P. Liver transplantation using grafts from donors after circulatory death: a propensity Score-Matched Study From a Single Center. Am J Transplant. 2016;16(6):1795–804.CrossRefGoogle Scholar
  9. 9.
    Mathur AK, Heimbach J, Steffick DE, Sonnenday CJ, Goodrich NP, Merion RM. Donation after cardiac death liver transplantation: predictors of outcome. Am J Transplant. 2010;10(11):2512–9.CrossRefGoogle Scholar
  10. 10.
    Mihaylov P, Mangus R, Ekser B, Cabrales A, Timsina L, Fridell J, Lacerda M, Ghabril M, Nephew L, Chalasani N, Kubal CA. Expanding the donor pool with the use of extended criteria donation after circulatory death livers. Liver Transpl. 2019;25(8):1198–208.PubMedGoogle Scholar
  11. 11.
    Pan X, Apinyachon W, Xia W, Hong JC, Busuttil RW, Steadman RH, Xia VW. Perioperative complications in liver transplantation using donation after cardiac death grafts: a propensity-matched study. Liver Transpl. 2014;20(7):823–30.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of SurgeryMayo Clinic ArizonaPhoenixUSA

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