Donation After Circulatory Death in Heart and Lung Transplanation

Donation after circulatory death (DCD) has become an increasingly utilized method of organ procurement for transplantation. There is an ever-increasing demand for organs which outpaces traditional procurement practices of donation after brain death (DBD), creating ongoing interest in alternative methods to expand the donor pool. DCD allows organ procurement following the full withdrawal of life sustaining measures, cessation of cardiac function, and formal declaration of death. Although DCD is not a novel concept, advances in donor assessment, organ preservation, ex vivo perfusion, and normothermic regional perfusion (NRP) have expanded its use, including heart and lung transplantation. There is ongoing debate regarding the adoption of DCD given the variability in donor and recipient selection, procurement practices, and institutional protocols. As DCD use continues to expand in the US and internationally, a comprehensive review of its evolution, current practice, outcomes, controversies, and anticipated future directions is warranted. This series will examine DCD transplantation across these subjects with particular interest in clinical practice. Planned Topics: History and Current Status: DBD vs DCD; early history and evolution of DCD; its current utilization in the US and internationally. Patient and Donor Selection: Identification and evaluation of potential donors and recipients; current selection criteria and guidelines; time to death; organ allocation; donor-recipient matching. Technical Aspect of Procurement: Current DCD procurement pathways; full withdrawal of life-sustaining treatment; determination of death and no-touch periods; procurement and perfusion versus NRP; prevention of cerebral perfusion; assessment of organ viability; preservation; and organ recovery. DCD Heart Transplantation: Cardiac physiology following circulatory arrest and warm ischemic injury; NRP and direct procurement strategies; ex vivo heart perfusion; primary graft dysfunction; short- and long-term outcomes; and comparison with DBD heart transplantation. DCD Lung Transplantation: Pulmonary physiology following circulatory arrest; donor assessment; direct procurement and NRP; ex vivo lung perfusion; primary graft dysfunction; chronic lung allograft dysfunction; utilization; and long-term outcomes. Ethics of DCD: Determination of death; withdrawal of life-sustaining treatment; separation of treatment and donation decisions; informed consent; the Dead Donor Rule; NRP and cerebral reperfusion; conflicts of interest and financial incentives; transparency; equity; and public trust. Future Directions in the US: Standardization of DCD procurement and NRP protocols; the evolving role of organ procurement organizations; advances in organ preservation and assessment; artificial intelligence and predictive donor-recipient matching; equitable access; and the evolving regulatory and financial landscape. Topic editors: Alessandra Francica, J Michael DiMaio Source: https://www.frontiersin.org/research-topics/86216/donation-after-circulatory-death-in-heart-and-lung-transplanation