Warm Ischemia Time

  • Kristopher P. Croome
  • C. Burcin TanerEmail author


Donation after circulatory death (DCD) donors differ from donation after brain death (DBD) donors in that they experience a period of obligatory donor warm ischemia time (DWIT) prior to initiation of cold perfusion of organs. While most authors agree that prolonged DWIT results in hepatic ischemic injury, debate exists on the length of DWIT or hemodynamic parameters following withdrawal of life support that determine whether a liver graft can be used with reasonable safety. As such, the concept of a functional warm ischemia time (f-DWIT) arose from the notion that individual events during DCD procurement, such as variations in hemodynamics, mandatory wait period, and time from incision to cannulation of the aorta and cross clamp, all of which are included in total DWIT, may have different impact on the outcome of the liver graft. The present chapter reviews the various definitions relevant to warm ischemia time in liver transplantation using DCD donors in an attempt to clarify the existing ambiguity. The chapter also provides a comprehensive view of the literature by describing studies that have investigated various parameters of warm ischemia time and their associations with outcomes following liver transplant using DCD donors, such as graft failure and ischemic cholangiopathy (IC). Finally the chapter reviews potential reasons for the variability in previous studies as well as discusses the limitations associated with using various hemodynamic parameters to evaluate hepatic ischemic injury.


DCD Functional warm ischemia time DWIT Ischemic cholangiopathy Asystole Transplant Liver 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of TransplantationMayo Clinic FloridaJacksonvilleUSA

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