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Time to death after withdrawal of treatment in donation after circulatory death (DCD) donors

Bradley, J.A.; Pettigrew, G.J.; Watson, C.J.

Current Opinion in Organ Transplantation: April 2013 - Volume 18 - Issue 2 - p 133–139
doi: 10.1097/MOT.0b013e32835ed81b
ORGAN PRESERVATION AND PROCUREMENT: Edited by Ernest van Heurn

Purpose: Controlled donation after circulatory death (DCD) donors make an important contribution to organ transplantation but there is considerable scope for further increasing the conversion of potential to actual DCD organ donors. The period between withdrawal of life-supporting treatment and death (the withdrawal period) is a major determinant of whether organ donation proceeds and it is therefore timely to review recent relevant studies in this area.

Recent Findings: The duration and haemodynamic nature of the withdrawal period is extremely variable, and clinical guidelines for management of the potential donor during this period differ widely. Recent evidence suggests that kidneys from DCD donors with a prolonged withdrawal period can be used to increase the number of transplants performed and provide satisfactory graft function, suggesting that it is not the duration but the haemodynamic profile of the donor during this phase that are important. This suggestion questions the relevance of clinical indices predicting death within 1 h of treatment withdrawal.

Summary: Future studies should aim to define clinical and physiological variables during the withdrawal period that can be used to maximize well tolerated use of organs from potential DCD donors; these thresholds are likely to differ according to organ type.

Department of Surgery, University of Cambridge, and Cambridge NIHR Biomedical Research Centre, Cambridge, United Kingdom

Correspondence to Professor J. Andrew Bradley, University Department of Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom. CB2 0QQ. Tel: +44 122 333 6976; e-mail: jab52@cam.ac.uk

© 2013 Lippincott Williams & Wilkins, Inc.