Advertisement

How to Initiate DCD Program for Liver Transplantation

  • Paolo Muiesan
  • Francesca Tinti
  • Anna Paola Mitterhofer
Chapter

Abstract

Donation after circulatory death (DCD) arguably has the greatest potential to provide transplantable organs. The vast majority of people die of causes that do not lead to brain death (98 %) [1] and thus DCD could meet the needs of organ transplantation based upon the actual numbers of potential donors alone. DCD liver transplantation has also played a unique role in the genesis of solid organ transplantation and paved the way for early pioneers of the speciality.

There are many challenges, however, to start successful DCD programs. In contemporary practice, despite large numbers of potential donors, DCD is not the ideal solution to the shortage of organs for transplantation due to complications relating primarily to ischaemia-reperfusion injury which are responsible for primary non-function (PNF) and/or delayed graft function. The liver is particularly sensitive to ischaemia-reperfusion injury and displays organ-specific damage in terms of biliary ischaemia. Ethical issues, societal idiosyncrasies and religious beliefs vary between nations and have a vast impact upon organ donation. Some of the more important issues that affect DCD follow. Controlled DCD was not possible in some countries, such as Spain, where withdrawal of life-sustaining treatment was not an accepted practice. However, this is changing and a pilot controlled DCD is on its way; as all religious scriptures were created before organ donation no religion states organ donation should be prohibited though some individuals perceive this to be so [2]; there is a perception by some people that efforts at resuscitation, provided by healthcare professionals, would be negatively influenced if uncontrolled DCD was a possible outcome for the patient in cardiac arrest [3]; certain noninvasive and invasive procedures are required during uncontrolled DCD before consent for donation can be sought. Finally, there are difficult logistic issues surrounding liver procurement, particularly for uncontrolled DCD. Thus the process of DCD is presented with strong challenges from society, individuals and the technical and logistical process of liver procurement itself.

Keywords

Brain Death Liver Graft Ischaemic Injury Donation After Circulatory Death Recipient Selection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Centers for Disease Control and Prevention. Vital Stat Rep. 2002;50Google Scholar
  2. 2.
    Randhawa G. Death and organ donation: meeting the needs of multiethnic and multifaith populations. Br J Anaesth. 2012;108 Suppl 1:i88–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Volk ML, Warren GJ, Anspach RR, Couper MP, Merion RM, Ubel PA. Attitudes of the American public toward organ donation after uncontrolled (sudden) cardiac death. Am J Transplant. 2010;10:675–80.PubMedCrossRefGoogle Scholar
  4. 4.
    Kootstra G, Kievit J, Nederstigt A. Organ donors: heartbeating and non-heartbeating. World J Surg. 2002;26:181–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Starzl TE, Marchioro TL, Huntley RT, Rifkind D, Rowlands DT, Dickinson Jr TC. Experimental and clinical homotransplantation of the liver. Ann N Y Acad Sci. 1964;120:739–65.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Calne RY, Williams R. Liver transplantation in man. I. Observations on technique and organization in five cases. Br Med J. 1968;4:535–40.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    Diagnosis of brain death. Statement issued by the honorary secretary of the Conference of Medical Royal Colleges and their Faculties in the United Kingdom on 11 October 1976. Br Med J. 1976;2:1187–88.Google Scholar
  9. 9.
    Diagnosis of Brain Death. Lancet. 1976;2:1069–70.Google Scholar
  10. 10.
    Weber M, Dindo D, Demartines N, Ambuhl PM, Clavien PA. Kidney transplantation from donors without a heartbeat. N Engl J Med. 2002;347:248–55.PubMedCrossRefGoogle Scholar
  11. 11.
    Akoh JA, Denton MD, Bradshaw SB, Rana TA, Walker MB. Early results of a controlled non-heart-beating kidney donor programme. Nephrol Dial Transplant. 2009;24:1992–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Summers DM, Johnson RJ, Allen J, Fuggle SV, Collett D, Watson CJ, et al. Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study. Lancet. 2010;376:1303–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, et al. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg. 2005;242:724–31.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Casavilla A, Ramirez C, Shapiro R, Nghiem D, Miracle K, Bronsther O, et al. Experience with liver and kidney allografts from non-heart-beating donors. Transplantation. 1995;59:197–203.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    D'Alessandro AM, Hoffmann RM, Knechtle SJ, Odorico JS, Becker YT, Musat A, et al. Liver transplantation from controlled non-heart-beating donors. Surgery. 2000;128:579–88.PubMedCrossRefGoogle Scholar
  16. 16.
    Abt PL, Desai NM, Crawford MD, Forman LM, Markmann JW, Olthoff KM, et al. Survival following liver transplantation from non-heart-beating donors. Ann Surg. 2004;239:87–92.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Muiesan P, Girlanda R, Jassem W, Melendez HV, O'Grady J, Bowles M, et al. Single-center experience with liver transplantation from controlled non-heartbeating donors: a viable source of grafts. Ann Surg. 2005;242:732–8.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Reich DJ, Munoz SJ, Rothstein KD, Nathan HM, Edwards JM, Hasz RD, et al. Controlled non-heart-beating donor liver transplantation: a successful single center experience, with topic update. Transplantation. 2000;70:1159–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Abt P, Crawford M, Desai N, Markmann J, Olthoff K, Shaked A. Liver transplantation from controlled non-heart-beating donors: an increased incidence of biliary complications. Transplantation. 2003;75:1659–63.PubMedCrossRefGoogle Scholar
  20. 20.
    Kaczmarek B, Manas MD, Jaques BC, Talbot D. Ischemic cholangiopathy after liver transplantation from controlled non-heart-beating donors-a single-center experience. Transplant Proc. 2007;39:2793–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Monbaliu D, Van GF, Troisi R, De HB, Lerut J, Reding R, et al. Liver transplantation using non-heart-beating donors: Belgian experience. Transplant Proc. 2007;39:1481–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Coggon J, Brazier M, Murphy P, Price D, Quigley M. Best interests and potential organ donors. BMJ. 2008;336:1346–7.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Richards B, Rogers WA. Organ donation after cardiac death: legal and ethical justifications for antemortem interventions. Med J Aust. 2007;187:168–70.PubMedGoogle Scholar
  24. 24.
    Bell MD. Non-heart beating organ donation: old procurement strategy–new ethical problems. J Med Ethics. 2003;29:176–81.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Bell MD. Non-heart beating organ donation: in urgent need of intensive care. Br J Anaesth. 2008;100:738–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Gardiner D, Riley B. Non-heart-beating organ donation – solution or a step too far? Anaesthesia. 2007;62:431–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Mandell MS, Zamudio S, Seem D, McGaw LJ, Wood G, Liehr P, et al. National evaluation of healthcare provider attitudes toward organ donation after cardiac death. Crit Care Med. 2006;34:2952–8.PubMedGoogle Scholar
  28. 28.
    Department of Health. Organ donation after circulatory death. Report of a consensus meeting. Intensive Care Society, NHS Blood and Transplant, and British Transplantation Society, 2010. Available from http://www.ics.ac.uk/intensive_care_professional/standards_and_guidelines/dcd.
  29. 29.
    Dominguez-Gil B, Haase-Kromwijk B, Van LH, Neuberger J, Coene L, Morel P, et al. Current situation of donation after circulatory death in European countries. Transpl Int. 2011;24:676–86.PubMedCrossRefGoogle Scholar
  30. 30.
    Bernat JL, D'Alessandro AM, Port FK, Bleck TP, Heard SO, Medina J, et al. Report of a national conference on donation after cardiac death. Am J Transplant. 2006;6:281–91.PubMedCrossRefGoogle Scholar
  31. 31.
    Stewart ZA, Cameron AM, Singer AL, Montgomery RA, Segev DL. Histidine-Tryptophan-Ketoglutarate (HTK) is associated with reduced graft survival in deceased donor livers, especially those donated after cardiac death. Am J Transplant. 2009;9:286–93.PubMedCrossRefGoogle Scholar
  32. 32.
    Fondevila C, Hessheimer AJ, Ruiz A, Calatayud D, Ferrer J, Charco R, et al. Liver transplant using donors after unexpected cardiac death: novel preservation protocol and acceptance criteria. Am J Transplant. 2007;7:1849–55.PubMedCrossRefGoogle Scholar
  33. 33.
    Jimenez-Galanes S, Meneu-Diaz MJ, Elola-Olaso AM, Perez-Saborido B, Yiliam FS, Calvo AG, et al. Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation. Liver Transpl. 2009;15:1110–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Otero A, Gomez-Gutierrez M, Suarez F, Arnal F, Fernandez-Garcia A, Aguirrezabalaga J, et al. Liver transplantation from Maastricht category 2 non-heart-beating donors. Transplantation. 2003;76:1068–73.PubMedCrossRefGoogle Scholar
  35. 35.
    Quintela J, Gala B, Baamonde I, Fernandez C, Aguirrezabalaga J, Otero A, et al. Long-term results for liver transplantation from non-heart-beating donors maintained with chest and abdominal compression-decompression. Transplant Proc. 2005;37:3857–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Fondevila C, Hessheimer AJ, Flores E, Ruiz A, Mestres N, Calatayud D, et al. Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation. Am J Transplant. 2012;12:162–70.PubMedCrossRefGoogle Scholar
  37. 37.
    Huddle TS, Schwartz MA, Bailey FA, Bos MA. Death, organ transplantation and medical practice. Philos Ethics Humanit Med. 2008;3:5.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Kaufman BJ, Wall SP, Gilbert AJ, Dubler NN, Goldfrank LR. Success of organ donation after out-of-hospital cardiac death and the barriers to its acceptance. Crit Care. 2009;13:189.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Fondevila C, Hessheimer AJ, Maathuis MH, Munoz J, Taura P, Calatayud D, et al. Superior preservation of DCD livers with continuous normothermic perfusion. Ann Surg. 2011;254:1000–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Gong J, Lao XJ, Wang XM, Long G, Jiang T, Chen S. Preservation of non-heart-beating donor livers in extracorporeal liver perfusion and histidine-trytophan-ketoglutarate solution. World J Gastroenterol. 2008;14:2338–42.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Butler AJ, Rees MA, Wight DG, Casey ND, Alexander G, White DJ, et al. Successful extracorporeal porcine liver perfusion for 72 hr. Transplantation. 2002;73:1212–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Imber CJ, St Peter SD, Lopez dC, I, Pigott D, James T, Taylor R et al. Advantages of normothermic perfusion over cold storage in liver preservation. Transplantation. 2002;73:701.Google Scholar
  43. 43.
    Guarrera JV, Henry SD, Samstein B, Odeh-Ramadan R, Kinkhabwala M, Goldstein MJ, et al. Hypothermic machine preservation in human liver transplantation: the first clinical series. Am J Transplant. 2010;10:372–81.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Paolo Muiesan
    • 1
  • Francesca Tinti
    • 1
    • 2
  • Anna Paola Mitterhofer
    • 2
  1. 1.The Liver Unit, HPB Surgery and Liver Transplantation, Queen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS TrustEdgbaston, BirminghamUK
  2. 2.Department of Clinical MedicineSapienza University of RomeRomeItaly

Personalised recommendations