Traumatic Brain Injury (TBI) (see Traumatic Brain Injury, [[Traumatic Brain Injury]]): 11.3% of cases
Respiratory Disease: 5% of cases
Cardiac Arrest (see Cardiac Arrest, [[Cardiac Arrest]]): 1.5% of cases
Other: 4.9% of cases
Technique
Definitions
Organ Harvest After Death is Confirmed by Circulatory Criteria
Modified Maastricht Classification of Donation After Circulatory Death (Transplant Proc, 1995) [MEDLINE]
Type I
Description: Dead on Arrival
Type of DCD: Uncontrolled DCD
Location: ED in a Transplant Center
Type II
Description: Unsuccessful Resuscitation
Type of DCD: Uncontrolled DCD
Location: ED in a Transplant Center
Type III
Description: Anticipated Cardiac Arrest
Type of DCD: Controlled DCD
Location: ICU and ED
Type IV
Description: Cardiac Arrest in a Brain Dead Donor
Type of DCD: Controlled DCD
Location: ICU and ED
Type V
Description: Unexpected Arrest in ICU Patient
Type of DCD: Uncontrolled DCD
Location: ICU in a Transplant Center
Warm Ischemic Injury in Controlled DCD
Organs from DCD Donors are Exposed to a Longer Duration of Warm Ischemia than Organs from Donation After Brain Death Donors
Warm Ischemia Occurs to Some Extent During Preceding Phase of Cardiovascular Collapse: which precedes asystole
Warm Ischemia Occurs to the Greatest Degree Between the Onset of Asystole and the Establishment of Cold Organ Perfusion
“Functional Warm Ischemia Time”: begins when the systolic blood pressure falls below 50 mm Hg and/or the SaO2 falls below 70% and ends with cold perfusion
There is a Defined Interval Between Withdrawal of Care (Most Commonly Reduction/Withdrawal of Ventilation or Extubation) and the Onset of Asystole
While Not Universally Agreed Upon, Many Criteria Specify that Death Can Be Confirmed After 5 min of Continuous Cardiopulmonary Arrest (Including Asystole)
Ischemic Injury
Increases the Risk of Primary Graft Failure
Increases Other Complications: such as biliary stricture, etc
Interventions Which Might Prevent/Reverse Ischemic Injury
Ante-Mortem Interventions
Corticosteroids
Heparin
Vasodilators
Consistent Application of Published Schedules for the Prompt Identification of Death
Decrease in Time Interval Between Diagnosis of Death and Organ Retrieval: therefore, withdrawal of treatment in the operating room is commonly practiced
Post-Mortem Reperfusion of Particularly Vulnerable Organs (Liver, etc)
Early Tissue Typing to Allow Prompt Identification and Mobilization of Suitable Recipients
Clinical Outcomes
Kidneys Harvested by DCD Have the Same Outcome than Those Harvested by Donation After Brain Death
References
Categories of non-heart beating organ donors. Transplant Proc 1995; 27: 2893–4 [MEDLINE]
