Expanding controlled donation after the circulatory determination of death: statement from an international collaborative
- PMID: 33635355
- PMCID: PMC7907666
- DOI: 10.1007/s00134-020-06341-7
Expanding controlled donation after the circulatory determination of death: statement from an international collaborative
Erratum in
-
Correction to: Expanding controlled donation after the circulatory determination of death: statement from an international collaborative.Intensive Care Med. 2021 Sep;47(9):1059-1060. doi: 10.1007/s00134-021-06435-w. Intensive Care Med. 2021. PMID: 34129053 Free PMC article. No abstract available.
Abstract
A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.
Keywords: Determination of death; Donation after the circulatory determination of death; Normothermic regional perfusion; Organ perfusion; Organ repair; Organ transplantation; Tissue and organ procurement; Withdrawal of life-sustaining therapy.
Conflict of interest statement
SK is a co-founder of Perfusix Canada (PXCA). This company provides ex situ lung perfusion (EVLP) services and training to University Health Network. Due to conflict of interest relative to EVLP activities as lung transplant surgeons in the institution, SK does not receive any payments from PXCA. Furthermore, with respect to the provision of EVLP services, PXCA is a non-profit company that does not generate profit from EVLP activities provided for UHN patients. SK is a co- founders of XOR Labs Toronto (XOR), a company dedicated to development of EVLP machines. The XOR EVLP machine is in development phase and has not been used in any patients reported on in this manuscript. Lung Bioengineering (LBI), a subsidiary of United Therapeutics, acquired Perfusix USA in 2015, a company that was co-founded by SK. Currently SK is a paid consultant for LBI. He provides strategic advice to LBI lung perfusion center as a member of its Scientific Advisory Board. DVR was a principal investigator in the Inspire and Expand trial sponsored by Transmedics, Inc (Andover, MA, USA). He received travel reimbursement to attend scientific advisory board meetings organized by Transmedics. The rest of the authors declare no conflicts of interest.
Figures
Comment in
-
Organ donation after controlled cardiocirculatory death: confidence by clarity.Intensive Care Med. 2021 Mar;47(3):325-327. doi: 10.1007/s00134-021-06362-w. Epub 2021 Feb 23. Intensive Care Med. 2021. PMID: 33620510 Free PMC article. No abstract available.
-
Organ donation after circulatory death: please do not waste time!Intensive Care Med. 2021 Jun;47(6):720-721. doi: 10.1007/s00134-021-06386-2. Epub 2021 Apr 1. Intensive Care Med. 2021. PMID: 33792749 No abstract available.
-
Organ donation after circulatory death: please avoid undue haste!Intensive Care Med. 2021 Jun;47(6):722-723. doi: 10.1007/s00134-021-06391-5. Epub 2021 Apr 2. Intensive Care Med. 2021. PMID: 33797575 No abstract available.
-
Expanding controlled donation after the circulatory determination of death: stronger emphasis on different cultural, religious and legal backgrounds is needed.Intensive Care Med. 2021 Jun;47(6):724-725. doi: 10.1007/s00134-021-06405-2. Epub 2021 Apr 27. Intensive Care Med. 2021. PMID: 33904947 Free PMC article. No abstract available.
Similar articles
-
cDCDD-NRP is consistent with US legal standards for determining death.Am J Transplant. 2022 Oct;22(10):2302-2305. doi: 10.1111/ajt.17083. Epub 2022 May 18. Am J Transplant. 2022. PMID: 35510751 Free PMC article.
-
Heart transplantation from controlled donation after circulatory death using thoracoabdominal normothermic regional perfusion and cold storage.J Card Surg. 2021 Sep;36(9):3421-3424. doi: 10.1111/jocs.15733. Epub 2021 Jun 12. J Card Surg. 2021. PMID: 34117800
-
Lung Quality and Utilization in Controlled Donation After Circulatory Determination of Death Within the United States.Am J Transplant. 2016 Apr;16(4):1207-15. doi: 10.1111/ajt.13599. Epub 2016 Feb 4. Am J Transplant. 2016. PMID: 26844673 Free PMC article.
-
Controlled Donation After Circulatory Determination of Death.J Intensive Care Med. 2017 Mar;32(3):179-186. doi: 10.1177/0885066615625628. Epub 2016 Jul 7. J Intensive Care Med. 2017. PMID: 26905540 Review.
-
Donation after circulatory death: current practices, ongoing challenges, and potential improvements.Transplantation. 2014 Feb 15;97(3):258-64. doi: 10.1097/01.TP.0000437178.48174.db. Transplantation. 2014. PMID: 24492420 Review.
Cited by
-
Lung Transplantation in Controlled Donation after Circulatory-Determination-of-Death Using Normothermic Abdominal Perfusion.Transpl Int. 2024 May 1;37:12659. doi: 10.3389/ti.2024.12659. eCollection 2024. Transpl Int. 2024. PMID: 38751771 Free PMC article. Review.
-
Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study.Crit Care. 2024 May 13;28(1):160. doi: 10.1186/s13054-024-04949-5. Crit Care. 2024. PMID: 38741176 Free PMC article.
-
Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study.Ann Intensive Care. 2024 Mar 6;14(1):35. doi: 10.1186/s13613-024-01265-7. Ann Intensive Care. 2024. PMID: 38448746 Free PMC article.
-
Knowledge gaps in heart and lung donation after the circulatory determination of death: Report of a workshop of the National Heart, Lung, and Blood Institute.J Heart Lung Transplant. 2024 Jun;43(6):1021-1029. doi: 10.1016/j.healun.2024.02.1455. Epub 2024 Mar 2. J Heart Lung Transplant. 2024. PMID: 38432523
-
Extracorporeal cardiopulmonary resuscitation in 2023.Intensive Care Med Exp. 2023 Oct 30;11(1):74. doi: 10.1186/s40635-023-00558-8. Intensive Care Med Exp. 2023. PMID: 37902904 Free PMC article. Review. No abstract available.
References
-
- WHO Guiding Principles on human cell, tissue and organ transplantation. Available at: https://www.who.int/transplantation/Guiding_PrinciplesTransplantation_WH.... Accessed Sep 2020
-
- Global Observatory on Organ Donation and Transplantation. Available at: http://www.transplant-observatory.org. Accessed Sep 2020
-
- The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. Available at: https://declarationofistanbul.org. Accessed Sep 2020
-
- Organización Nacional de Trasplantes, The Transplantation Society, World Health Organization The Madrid resolution on organ donation and transplantation: national responsibility in meeting the needs of patients, guided by the WHO principles. Transplantation. 2011;91(Suppl 11):S29–31. doi: 10.1097/01.tp.0000399131.74618.a5. - DOI - PubMed
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical