Uncontrolled Donation after Circulatory Death: European practices and recommendations for the development and optimization of an effective programme.

Abstract

Shortage of organs has made a global interest for donation after circulatory death (DCD) to re-emerge. While controlled DCD (cDCD) has been progressively increasing, uncontrolled DCD (uDCD) has only been developed in a few settings.1 This activity is quantitatively important in France and Spain, although it has also been reported in other European countries, as Austria, Belgium, Italy, the Netherlands, and recently in Russia.2,3 uDCD protocols have allowed the transplantation of a significant number of kidneys, livers and lungs at these countries.3 Excellent graft survival has been reported in kidney transplantation from uDCD, in spite of an increased incidence of delayed graft function (DGF).4,5,6,7,8,9,10,11,12,13,14,1516 Albeit promising, results with liver transplants obtained in uDCD protocols do not consistently provide similar outcomes compared with livers from donors after brain death (DBD), mainly due to a higher incidence of primary graft dysfunction and non-function and biliary complications.17,18,19,20,21,22 Lung transplantation is still facing limited experience, but preliminary results are encouraging.