How to Initiate a DCD Programme for Kidney Transplantation
Organ donation after circulatory death (DCD) has become an important source of organs for transplantation. The number of DCD donors is increasing in contrast to donation after brain death (DBD). This decline in DBD donors has been attributed to better road safety and improved care of patients with major trauma and cerebrovascular haemorrhage. There has been a considerable experience with DCD donor kidney transplantation. DCD kidneys have a higher incidence of delayed graft function but similar long-term function compared to DBD donors. Maastricht Category 1 and 2 donors are also termed “uncontrolled” and there is little experience with this type of donation. Most of these donors are patients presenting to the emergency department after a cardiac arrest out of the hospital or in the hospital with unsuccessful resuscitation. After declaration of death, organ donation is considered. Hence, these organs sustain a prolonged warm ischaemia. Category 3 donors are termed “controlled”. These patients are usually in the intensive care unit where a decision is made to withdraw support due to poor prognosis. Family consent for donation is obtained and the retrieval team mobilised prior to withdrawal of support. Hence warm ischaemia can be minimised. Controlled donation is being very successfully implemented in countries such as the UK.