Rapid Access in Donation After Circulatory Death (DCD): The Single-Center Experience With a Classic Pathway in Uncontrolled DCD Algorithm |
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| Institution: | 1. Department of Nephrology, Internal Medicine and Transplantation, Pomeranian Medical University, Szczecin, Poland;2. Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland;1. Department of Pharmacy, Sentara Norfolk General Hospital, Norfolk, Virginia;2. Sound Physicians, Richmond Community Hospital, Richmond, Virginia;3. Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia;4. Department of Surgery, Sentara Norfolk General Hospital, Norfolk, Virginia;5. Kidney/Pancreas Transplant Department, Sentara Norfolk General Hospital, Norfolk, Virginia;6. Transplant Department, Children''s Hospital of the King''s Daughters, Norfolk, Virginia;7. Tidewater Kidney Specialists, Norfolk, Virginia;1. Department of Critical Care Medicine, Yantaishan Hospital, Yantai, Shandong, P. R. China;2. Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA;1. Division of Cardiac Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna Policlinico di S. Orsola, Alma Mater Studiorum, University of Bologna, Bologna, Italy;2. Division of Cardiology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna Policlinico di S. Orsola, Alma Mater Studiorum, University of Bologna, Bologna, Italy;1. Department of Medical Pharmacology, Biruni University School of Medicine, Istanbul, Turkey;2. Department of Obstetrics and Gynecology, Biruni University School of Medicine, Istanbul, Turkey;3. Department of Obstetrics and Gynecology, Medicana International Istanbul Hospital, Istanbul, Turkey;1. Department of Psychology, Karnataka University, Dharwad, India;2. Department of Psychology, Jean-Jaurs University, Toulouse, France;3. Department of Human Sciences, Humanities and Communication, University of Quluq, Montreal, Quebec, Canada;4. Departments of Pediatrics and Internal Medicine, Albany Medical College, Albany, New York;5. Department of Ethics and Work, Institute of Advanced Studies (EPHE), Paris, France;1. Division of Nephrology, Department of Internal Medicine, Medical Faculty, TC Demiro?lu Bilim University, ?stanbul, Turkey;2. Division of Nephrology, Department of Internal Medicine, Medical Faculty, Sivas Cumhuriyet University, Sivas, Turkey;3. Unit of Renal Transplantation, Department of General Surgery, Medical Faculty, TC Demiro?lu Bilim University, ?stanbul, Turkey. |
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| Abstract: | BackgroundIn Poland, 95% of organs for transplantation come from donation after brain death (DBD). In 2010, Poland officially joined the European countries in which donation after circulatory death is accepted by law. Currently, the Pomeranian Medical University Transplant Center is the only active location for uncontrolled donation after circulatory death (uDCD) in Poland. To estimate the results of uDCD kidney transplantation with a classical approach to organ recovery, we analyzed data from an early phase of uDCD program.MethodsProspective observation of uDCD kidney allografts (group 1; n = 8) compared with DBD kidney allografts (group 2; n = 30). The organ recovery protocol was set up on rapid abdominal access without regional perfusion before procurement.ResultsThe organs recovered from uDCD during a 24-month period increased the volume of kidneys transplanted at the center by 9.2%. Delayed graft function was diagnosed in 100% vs 46% of allografts (P = .03), respectively. Nevertheless, early posttransplant follow-up did not reveal any graft loss or recipient death cases in the DCD group. After 12 months of follow-up, the mean glomerular filtration rate was 44.5 vs 57.9 mL/min (P < .02), respectively. Crucial factors for acceptable results of uDCD are strict pretransplant assessment of recovered organs and efficient coordination of the transplant team.ConclusionsConservative recovery protocol in uDCD under strict prerequisites is feasible to consider in the organ procurement pathway. Preliminary results provide space for an increase in the organ donor pool. |
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