Donors After Circulatory Death: Theme of Present or a Future? The Research in West Poland

A scoping review of the perceptions of death in the context of organ donation and transplantation

BACKGROUND

Socio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not been studied.

OBJECTIVES

In order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations.

STUDY APPRAISAL

A search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria.

RESULTS

32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained.

CONCLUSIONS

Our review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death.

Non-re-cooling implantation of marginal liver graft after machine perfusion: report of a case

Early allograft dysfunction (EAD), primary graft nonfunction (PNF) and biliary complications affect postoperative survival after liver transplantation (LT). Ischemia injury is one of the major factors affecting liver allograft functional recovery. Ischemia-free liver transplantation (IFLT) has obvious advantages for the recovery of allograft function and complication incidence compared with conventional procedures. However, its use is limited when the donor and the recipient are not in the same hospital and donors should be donor after brain death (DBD). We propose an approach to avoid double warm ischemic injury by implanting marginal donor liver directly by using normothermic machine perfusion (NMP) without re-cooling. Here, we report the first case of non-re-cooling implantation for marginal donor in LT. Donor liver biopsies before procurement showed 50% macrovesicular steatosis, and the recipient was a 67-year-old man with decompensated cirrhosis secondary to a 21-year hepatitis B virus (HBV) infection. The donor liver was maintained by NMP without re-cooling before implantation. The highest levels of alanine transaminase (ALT) and aspartate transaminase (AST) after surgery were 235 and 1,076 U/L, respectively, on the first postoperative day (POD). The patient was discharged within 2 weeks and showed good recovery. Thus, it is feasible to use Non-re-cooling implantation for marginal donor in LT.