https://deepblue.lib.umich.edu/bitstream/handle/2027.42/72729/j.1600-6135.2005.00832.x.pdf;sequence=1

Organ Donation and Utilization in the United States, 1996–2005

http://www.onelegacy.org/site/docs/NationalConferenceOnDCD_2006.pdf

Report of a National Conference on Donation after Cardiac Death

Liver transplantation remains the standard treatment for patients with end-stage liver disease. Over the years there have been significant improvements in liver transplant outcomes due to improved surgical techniques, organ preservation, immunosuppression, and anti-infective therapies. This success has resulted in more patients being listed for transplantation out of proportion to the number of available organs. Thus, the donor organ shortage remains a significant obstacle to increasing the number of liver transplants. In an attempt to combat the donor organ shortage, more liver transplant centers are using livers from donation after cardiac death (DCD) donors. Based on the Scientific Registry of Transplant Recipients (SRTR) 2007 Annual Report, there has been a seven-fold increase in the number of liver transplant programs performing DCD liver transplants over the last seven years. In addition the number of DCD liver transplants performed at centers in the United States increased from 39 in 2000 to 277 in 2007 (2007 OPTN/SRTR Annual Report. HHS/HRSA/HSB/DOT; UNOS; Arbor Research Collaborative for Health).

Despite this increase in DCD liver utilization, there remains reluctance among many centers to aggressively use these organs. This unwillingness is based on both national database and single-center studies reporting inferior patient and graft survival rates when compared to liver transplants from donation after brain death donors (DBD).1,2,3,4 Another important concern with the use of DCD livers is the development of biliary complications. The incidence of biliary complications after DCD liver transplantation ranges between 25–60%, 3,5,6,7,8 compared to 10–30% seen in DBD whole liver transplantation.9,10,11,12 The most critical biliary complication that frequently requires retransplantation is the development of ischemic-type biliary strictures or ischemic cholangiopathy. Ischemic cholangiopathy (IC) is defined as intra-hepatic or non-anastomotic, extra-hepatic biliary strictures in the presence of a patent hepatic artery. The incidence of IC in DCD liver transplantation ranges between 10–50% in published series.13,5,6,8,14 Although not all patients with IC require retransplantation, this complication can result in considerable patient morbidity including biliary sepsis, prolonged antibiotic therapy, and the requirement for multiple endoscopic or percutaneous biliary procedures. In addition, most patients with IC maintain excellent hepatocellular function despite biliary damage and dysfunction and therefore have relatively low Model for End-Stage Liver Disease (MELD) scores when being considered for retransplantation. In many cases requests for a MELD exception are made to the regional review boards in order to obtain a sufficient MELD score for re transplantation. The granting of these exceptions is quite variable across the country and not standardized in the current liver allocation process. This prolonged waiting time may result in recurrent biliary sepsis, the development of multi-resistant organisms, and patient debilitation that could potentially exclude them from retransplantation.

Previous analyses utilizing the United Network for Organ Sharing/Organ Procurement and Transplantation Network Liver Transplantation Registry have identified potential risk factors that are predictive of graft survival after DCD liver transplantation.15,16 However, the risk factors for the development biliary complications were not analyzed in these studies. The objectives of this analysis were (1) to compare the long-term outcomes of DCD and DBD liver transplants with 15 year follow-up, (2) to compare the incidence of biliary complications between DCD and DBD liver transplant recipients, and (3) to identify potential risk factors for the development of biliary complications in DCD liver transplant recipients at the University of Wisconsin.

/pdf/biliary-complications-after-liver-transplantation-from-5escv3anu5.pdf

Biliary complications after liver transplantation from donation after cardiac death donors: an analysis of risk factors and long-term outcomes from a single center.

This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus.

/pdf/management-of-the-potential-organ-donor-in-the-icu-society-17ltdvdbv2.pdf

Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement

Background:

The outcome of orthotopic liver transplantation (OLT) with controlled graft donation after cardiac death (DCD) is usually inferior to that with graft donation after brain death (DBD). This study compared outcomes from OLT with DBD versus controlled DCD donors with predefined restrictive acceptance criteria.



Methods:

All adult recipients in the Netherlands in 2001–2006 with full-size OLT from DCD (n = 55) and DBD (n = 471) donors were included. Kaplan–Meier, log rank and Cox regression analyses were used.



Results:

One- and 3-year patient survival rates were similar for DCD (85 and 80 per cent) and DBD (86·3 and 80·8 per cent) transplants (P = 0·763), as were graft survival rates (74 and 68 per cent versus 80·4 and 74·5 per cent; P = 0·212). The 3-year cumulative percentage of surviving grafts developing non-anastomotic biliary strictures was 31 per cent after DCD and 9·7 per cent after DBD transplantation (P < 0·001). The retransplantation rate was similar overall (P = 0·081), but that for biliary stricture was higher in the DCD group (P < 0·001). Risk factors for 1-year graft loss after DBD OLT were transplant centre, recipient warm ischaemia time and donor with severe head trauma. After DCD OLT they were transplant centre, donor warm ischaemia time and cold ischaemia time. DCD graft was a risk factor for non-anastomotic biliary stricture.



Conclusion:

OLT using controlled DCD grafts and restrictive criteria can result in patient and graft survival rates similar to those of DBD OLT, despite a higher risk of biliary stricture. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

https://bjssjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/bjs.7043

Similar liver transplantation survival with selected cardiac death donors and brain death donors

Objectives The objective of this analysis was to compare the results of transplantation of livers, pancreases, kidneys, and lungs from donation after cardiac death (DCD) donors to organs transplanted from donation after brain death (DBD) donors. Methods From January 1984 through July 2000, outcomes of 382 DCD kidneys were compared to 1,089 kidneys (SPK) transplants and 36 liver transplants from DCD donors were compared to 455 SPK and 510 liver transplants from DBD donors. Likewise, 31 simultaneous pancreas-kidneys transplants from DBD donors. Results The rate of delayed graft function (DGF) was higher in kidneys transplanted from DCD donors (27.5% versus 21.3%, p=0.01). Likewise, discharge creatinines were higher in recipients of DCD kidneys (1.9 mg/dL versus 1.7 mg/dL, p=0.001). There was no difference in 10-year graft survival between DCD and DBD recipients (45.0% versus 48.0%, p=0.054). No difference in 5-year pancreatic and renal allograft survival was seen after SPK from DCD or DBD donors. After liver transplantation, biliary strictures were higher in recipients of DCD livers (13.9% versus 8.0%, p=0.03). Likewise, 3-year patient and graft survivals were lower for recipients of DCD livers (65.8% versus 84.9%, p=0.01; and 58.6% versus 76.9%, p=0.006). Conclusions This large experience with transplantation from DCD donors demonstrates that similar patient and graft survivals can be expected when compared to recipients of organs from DBD donors.

Donation after cardiac death: the University of Wisconsin experience.

Methods and apparatuses for temperature modification of a patient, or selected regions thereof, including an induced state of hypothermia. The temperature modification is accomplished using an in-dwelling heat exchange catheter within which a fluid heat exchange medium circulates. A heat exchange cassette is attached to the circulatory conduits of the catheter, the heat exchange cassette being sized to engage a cavity within a control unit. The control unit includes a heater/cooler device for providing heated or cooled fluid to a heat exchanger in thermal communication with the fluid heat exchange medium circulating to the heat exchange catheter, a user input device, and a processor connected to receive input from various sensors around the body and the system. A temperature control scheme for ramping the body temperature up or down without overshoot is provided.

Apparatus and method for providing enhanced heat transfer from a body

System for providing enhanced heat transfer from a body

System for adjusting the temperature of a patient

A cassette for use in a system for adjusting the temperature of a patient. The cassette comprises a heat exchanger, the heat exchanger having a primary fluid circuit side and a secondary fluid circuit side. The primary fluid circuit side includes releasable couplers for releasably coupling to a primary fluid circuit. The secondary fluid circuit side is in fluid communication with a heat exchange catheter (263) insertable within a patient, a secondary fluid circuit (255), and a secondary fluid circuit pump (261) for flowing a heat exchange fluid through the secondary fluid circuit to the heat exchange catheter (263) and back through the secondary fluid circuit to the secondary fluid circuit pump (261). The releasable couplers (231,233) have check valves disposed therein to fluidly seal the primary fluid circuit side when the primary fluid circuit side is not connected to the primary fluid circuit to minimize primary fluid loss from the primary fluid circuit side of the heat exchanger

Apparatus for providing enhanced heat transfer from a body

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