ASTS Recommended Practice Guidelines for Controlled Donation after Cardiac Death Organ Procurement and Transplantation

• Published in: American journal of transplantation Vol. 9; no. 9; pp. 2004 - 2011
• Main Authors: Reich, D. J., Mulligan, D. C., Abt, P. L., Pruett, T. L., Abecassis, M. M. I., D’Alessandro, A., Pomfret, E. A., Freeman, R. B., Markmann, J. F., Hanto, D. W., Matas, A. J., Roberts, J. P., Merion, R. M., Klintmalm, G. B. G.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.09.2009; Wiley
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Brain Death; Clinical death. Palliative care. Organ gift and preservation; Death; Expanded criteria donors; extended donor criteria; extended donor pool; Humans; Kidney Transplantation - standards; Liver Transplantation - standards; Medical sciences; Organ Transplantation - methods; Organ Transplantation - standards; Pancreas Transplantation - standards; Prognosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue and Organ Harvesting - standards; Tissue and Organ Procurement - methods; Tissue and Organ Procurement - standards; Tissue Donors; Treatment Outcome; United States; United States; Heart; Suboptimal donor; Human; Expanded criteria donors; Mortality; Transplantation; Homotransplantation; Recommendation; Organ donation; Treatment; Criterion; extended donor criteria; Surgery; Professional practice; Donation; Graft; Death; Pool; extended donor pool; Circulatory system; Organ harvesting; Organ
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2009.02739.x

The American Society of Transplant Surgeons (ASTS) champions efforts to increase organ donation. Controlled donation after cardiac death (DCD) offers the family and the patient with a hopeless prognosis the option to donate when brain death criteria will not be met. Although DCD is increasing, this endeavor is still in the midst of development. DCD protocols, recovery techniques and organ acceptance criteria vary among organ procurement organizations and transplant centers. Growing enthusiasm for DCD has been tempered by the decreased yield of transplantable organs and less favorable posttransplant outcomes compared with donation after brain death. Logistics and ethics relevant to DCD engender discussion and debate among lay and medical communities. Regulatory oversight of the mandate to increase DCD and a recent lawsuit involving professional behavior during an attempted DCD have fueled scrutiny of this activity. Within this setting, the ASTS Council sought best‐practice guidelines for controlled DCD organ donation and transplantation. The proposed guidelines are evidence based when possible. They cover many aspects of DCD kidney, liver and pancreas transplantation, including donor characteristics, consent, withdrawal of ventilatory support, operative technique, ischemia times, machine perfusion, recipient considerations and biliary issues. DCD organ transplantation involves unique challenges that these recommendations seek to address. These evidence‐based ASTS practice guidelines address many aspects of controlled donation after cardiac death organ procurement and transplantation, including donor characteristics, principles of consent, withdrawal of ventilatory support, operative technique, ischemia times, machine perfusion, recipient considerations, and biliary issues.