History of Marginal Donors in the World

Abstract

Cadaver organ transplantation was started with donation after cardiac death (DCD). As determination of brain death was not established until 1968, the first liver transplant by Starzl et al. [1] in 1963 and the first heart transplant by Barnard [2] in 1967 were performed with DCD donors whose organs were procured under cardiopulmonary support (CPB). After the Harvard ad hoc committee [3] published the Harvard criteria for brain death in June 1968, organ donation from brain-dead persons has become the main current of cadaver organ transplantation. However, in Japan, only uncontrolled DCD kidney transplantation has been done since the 1960s, because brain-dead organ transplantation was not permitted for a long time.

As organ transplantation rapidly increased and organ shortage became more remarkable, DCD have been widely introduced in the clinical practice and the use of organs, especially kidneys, from DCD donors has been reported in multiple series [4] since the late 1980s in the developed countries. At that time, controlled DCD was the main current. Therefore, organs were harvested after cardiac death induced by extubation of the donor.

As percutaneous cardiopulmonary support (PCPS) was introduced in the clinical settings in the late 1980s, uncontrolled DCD using PCPS was initiated in Spain [5]. In 2000, Steen et al. [6] started uncontrolled DCD lung transplantation in Sweden.