ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation

D. J. Reich, D. C. Mulligan, P. L. Abt, T. L. Pruett, M. M.I. Abecassis, A. D'Alessandro, E. A. Pomfret, R. B. Freeman, J. F. Markmann, D. W. Hanto, A. J. Matas, J. P. Roberts, R. M. Merion, G. B.G. Klintmalm

Research output: Contribution to journalArticlepeer-review

233 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2004-2011
Number of pages8
JournalAmerican Journal of Transplantation
Volume9
Issue number9
DOIs
StatePublished - Sep 2009

Keywords

  • Expanded criteria donors
  • Extended donor criteria
  • Extended donor pool

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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