Skip to main content
SpringerLink
Log in

The Potential Organ Donor: Current Trends and Management

  • Chapter
Operative Techniques and Recent Advances in Acute Care and Emergency Surgery

  • 1620 Accesses

Abstract

Increasing numbers of trauma patients receive immediate and appropriate control of life-threatening injuries, but some of them eventually progress to brain death. Establishment of the best therapeutic strategies for patients with extensive and major trauma has led to significant improvement in donor conversion rates and increased utilization of deceased donors. Approximately 30% of all deceased organ donors are trauma patients who have suffered devastating neurologic injury and have progressed to brain death.

Donation rates have risen in the past decade, but many patients still die on the waiting list for organ transplants. Although most organs are from brain death donors, donation after cardiac death has come to be an additional resource in recent years. Optimizing selection and management of potential organ donors and exploring new strategies for maintenance of organ function have thus become a priority for expanding the transplantable organ pool. This chapter discusses organ donation from deceased donors, highlighting the margins of improvement in their management from declaration of death to organ recovery and outlining the possible applications of new perfusion technologies in this process.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Jenkins DH, Reilly PM, McMahon DJ, Hawthorne RV. Minimizing charges associated with the determination of brain death. Crit Care. 1997;1:65–70.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Keegan MT, Wood KE, Coursin DB. An update on ICU management of the potential organ donor. In: Vincent JL, editor. Intensive care medicine. Annual update 2010. Heidelberg: Springer; 2011. p. 547–59.

    Google Scholar 

  3. Israni AK, Zaun D, Bolch C, Rosendale JD, Snyder JJ, Kasiske BL. Deceased organ donation. Am J Transplant. 2016;16:195–215.

    Article  PubMed  Google Scholar 

  4. Trapianti—Statistiche. http://www.trapianti.salute.gov.it/cnt/cntStatistiche.jsp. Accessed 26 Mar 2017.

  5. De Carlis L, Lauterio A, De Carlis R, Ferla F, Di Sandro S. Donation after cardiac death liver transplantation after more than 20 minutes of circulatory arrest and Normothermic regional perfusion. Transplantation. 2016;100:e21–2.

    Article  PubMed  Google Scholar 

  6. De Carlis L, De Carlis R, Lauterio A, Di Sandro S, Ferla F, Zanierato M. Sequential use of normothermic regional perfusion and hypothermic machine perfusion in donation after cardiac death liver transplantation with extended warm ischemia time. Transplantation. 2016;100:e101–2.

    Article  PubMed  Google Scholar 

  7. De Carlis R, Di Sandro S, Lauterio A, Ferla F, Dell’Acqua A, Zanierato M, De Carlis L. Successful donation after cardiac death liver transplants with prolonged warm ischemia time using normothermic regional perfusion. Liver Transpl. 2017;23:166–73.

    Article  PubMed  Google Scholar 

  8. Manno EM, Wijdicks EFM. The declaration of death and the withdrawal of care in the neurologic patient. Neurol Clin. 2006;24:159–69.

    Article  PubMed  Google Scholar 

  9. De Carlis R, Sguinzi R, Grande AM, Aseni P. Multiple organ retrieval: general principles, organ preservation, and new strategies. In: Aseni P, Grande AM, De Carlis L, editors. Multiorgan procurement for transplantation. A guide to surgical technique and management. Heidelberg: Springer; 2016. p. 79–90.

    Chapter  Google Scholar 

  10. Ley EJ, Salim A. Organ donation. In: Velmahos GC, Degiannis E, Doll D, editors. Penetrating trauma: a practical guide on operative technique and peri-operative management. 2nd ed. Heidelberg: Springer; 2017. p. 623–8.

    Chapter  Google Scholar 

  11. Jenkins DH, Reilly PM, Schwab CW. Improving the approach to organ donation: a review. World J Surg. 1999;23:644–9.

    Article  CAS  PubMed  Google Scholar 

  12. Gazzetta Ufficiale—Decreto 11 aprile. 2008. http://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2008-06-12&atto.codiceRedazionale=08A04067&elenco30giorni=false. Accessed 26 Mar 2017.

  13. Abt PL, Marsh CL, Dunn TB, Hewitt WR, Rodrigue JR, Ham JM, Feng S. Challenges to research and innovation to optimize deceased donor organ quality and quantity. Am J Transplant. 2013;13:1400–4.

    Article  CAS  PubMed  Google Scholar 

  14. Glazier AK. The principles of gift law and the regulation of organ donation. Transpl Int. 2011;24:368–72.

    Article  PubMed  Google Scholar 

  15. Franz HG, DeJong W, Wolfe SM, Nathan H, Payne D, Reitsma W, Beasley C. Explaining brain death: a critical feature of the donation process. J Transpl Coord. 1997;7:14–21.

    CAS  PubMed  Google Scholar 

  16. Salim A, Velmahos GC, Brown C, Belzberg H, Demetriades D. Aggressive organ donor management significantly increases the number of organs available for transplantation. J Trauma. 2005;58:991–4.

    Article  PubMed  Google Scholar 

  17. Ferla F, De Carlis R, Mariani A, De Carlis L. Liver transplant using octogenarian donors. Liver Transpl. 2016;22:1040–1.

    Article  PubMed  Google Scholar 

  18. Lauterio A, Moioli MC, Di Sandro S, Travi G, De Carlis R, Merli M, Ferla F, Puoti M, De Carlis L. HIV-positive to HIV-positive liver transplantation: To be continued. J Hepatol. 2018;S0168-8278:32180–9.

    Google Scholar 

  19. Grande AM, Aseni P. Preoperative evaluation and arrangements for multiorgan donation: general principles and contraindications. In: Aseni P, Grande AM, De Carlis L, editors. Multiorgan procurement for transplantation: a guide to surgical technique and management. Heidelberg: Springer; 2016. p. 19–34.

    Chapter  Google Scholar 

  20. Neyrinck A, Raemdonck D, Van Monbaliud D. Donation after circulatory death: current status. Curr Opin Anaesthesiol. 2013;26:382–90.

    Article  PubMed  Google Scholar 

  21. Kootstra G, Daemen JH, Oomen AP. Categories of non-heart-beating donors. Transplant Proc. 1995;27:2893–4.

    CAS  PubMed  Google Scholar 

  22. Thuong M, Ruiz A, Evrard P, Kuiper M, Boffa C, Akhtar MZ, Neuberger J, Ploeg R. New classification of donation after circulatory death donors definitions and terminology. Transpl Int. 2016;29:749–59.

    Article  PubMed  Google Scholar 

  23. Balibrea JM, Núñez-Peña JR, García-Martín MC, Olmedilla Y, Martín-Antona E, Berthuin J, Rancan L, Vara E, Balibrea JL. The differential tissue expression of inflammatory, oxidative stress, and apoptosis markers in human uncontrolled non-heart-beating donors. Transplantation. 2013;95:1346–53.

    Article  CAS  PubMed  Google Scholar 

  24. Monbaliu D, Pirenne J, Talbot D. Liver transplantation using donation after cardiac death donors. J Hepatol. 2012;56:474–85.

    Article  PubMed  Google Scholar 

  25. Domínguez-Gil B, Haase-Kromwijk B, Van Leiden H, et al. Current situation of donation after circulatory death in European countries. Transpl Int. 2011;24:676–86.

    Article  PubMed  Google Scholar 

  26. Manara AR, Murphy PG, O’Callaghan G. Donation after circulatory death. Br J Anaesth. 2012;108:i108–21.

    Article  PubMed  Google Scholar 

  27. Rodríguez-Arias D, Deballon IO. Protocols for uncontrolled donation after circulatory death. Lancet. 2012;379:1275–6.

    Article  PubMed  Google Scholar 

  28. Morrissey PE, Monaco AP. Donation after circulatory death: current practices, ongoing challenges, and potential improvements. Transplantation. 2014;97:258–64.

    Article  PubMed  Google Scholar 

  29. Net M, Valero R, Almenara R, et al. The effect of normothermic recirculation is mediated by ischemic preconditioning in NHBD liver transplantation. Am J Transplant. 2005;5:2385–92.

    Article  CAS  PubMed  Google Scholar 

  30. Valero R, Cabrer C, Oppenheimer F, et al. Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors. Transpl Int. 2000;13:303–10.

    Article  CAS  PubMed  Google Scholar 

  31. Hessheimer AJ, Billault C, Barrou B, Fondevila C. Hypothermic or normothermic abdominal regional perfusion in high-risk donors with extended warm ischemia times: impact on outcomes? Transpl Int. 2015;28:700–7.

    Article  CAS  PubMed  Google Scholar 

  32. Hessheimer AJ, García-Valdecasas JC, Fondevila C. Abdominal regional in-situ perfusion in donation after circulatory determination of death donors. Curr Opin Organ Transplant. 2016;21:322–8.

    Article  PubMed  Google Scholar 

  33. Fondevila C, Hessheimer AJ, Flores E, et al. Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation. Am J Transplant. 2012;12:162–70.

    Article  CAS  PubMed  Google Scholar 

  34. Fondevila C, Hessheimer AJ, Ruiz A, et al. Liver transplant using donors after unexpected cardiac death: novel preservation protocol and acceptance criteria. Am J Transplant. 2007;7:1849–55.

    Article  CAS  PubMed  Google Scholar 

  35. Savier E, Dondero F, Vibert E, et al. First experience of liver transplantation with type 2 donation after cardiac death in France. Liver Transpl. 2015;21:631–43.

    Article  PubMed  Google Scholar 

  36. Oniscu GC, Randle LV, Muiesan P, Butler AJ, Currie IS, Perera MTPR, Forsythe JL, Watson CJE. In situ normothermic regional perfusion for controlled donation after circulatory death—the United Kingdom experience. Am J Transplant. 2014;14:2846–54.

    Article  CAS  PubMed  Google Scholar 

  37. Magliocca JF, Magee JC, Rowe SA, Gravel MT, Chenault RH, Merion RM, Punch JD, Bartlett RH, Hemmila MR. Extracorporeal support for organ donation after cardiac death effectively expands the donor pool. J Trauma. 2005;58:1095–101.

    Article  PubMed  Google Scholar 

  38. Casavilla A, Ramirez C, Shapiro R, Nghiem D, Miracle K, Bronsther O, Randhawa P, Broznick B, Fung JJ, Starzl T. Experience with liver and kidney allografts from non-heart-beating donors. Transplantation. 1995;59:197–203.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Reich DJ, Mulligan DC, Abt PL, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation. Am J Transplant. 2009;9:2004–11.

    Article  CAS  PubMed  Google Scholar 

  40. Ausania F, White SA, Pocock P, Manas DM. Kidney damage during organ recovery in donation after circulatory death donors: data from UK National Transplant Database. Am J Transplant. 2012;12:932–6.

    Article  CAS  PubMed  Google Scholar 

  41. Shapey IM, Muiesan P. Regional perfusion by extracorporeal membrane oxygenation of abdominal organs from donors after circulatory death: a systematic review. Liver Transpl. 2013;19:1292–303.

    Article  PubMed  Google Scholar 

  42. Moers C, Smits JM, M-HJ M, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med. 2009;360:7–19.

    Article  CAS  PubMed  Google Scholar 

  43. Jochmans I, Moers C, Smits JM, et al. The prognostic value of renal resistance during hypothermic machine perfusion of deceased donor kidneys. Am J Transplant. 2011;11:2214–20.

    Article  CAS  PubMed  Google Scholar 

  44. Schlegel A, de Rougemont O, Graf R, Clavien P-A, Dutkowski P. Protective mechanisms of end-ischemic cold machine perfusion in DCD liver grafts. J Hepatol. 2013;58:278–86.

    Article  PubMed  Google Scholar 

  45. Dutkowski P, Schlegel A, De Oliveira M, Müllhaupt B, Neff F, Clavien PA. HOPE for human liver grafts obtained from donors after cardiac death. J Hepatol. 2014;60:765–72.

    Article  PubMed  Google Scholar 

  46. Dutkowski P, Polak WG, Muiesan P, Schlegel A, Verhoeven CJ, Scalera I, DeOliveira ML, Kron P, Clavien P-A. First comparison of hypothermic oxygenated PErfusion versus static cold storage of human donation after cardiac death liver transplants: an international-matched case analysis. Ann Surg. 2015;262:764–71.

    Article  PubMed  Google Scholar 

  47. Geraci P, Sepe V. Non-heart-beating organ donation in Italy. Minerva Anestesiol. 2011;77:613–23.

    CAS  PubMed  Google Scholar 

  48. Vergano M, Magavern E, Baroncelli F, et al. Making a case for controlled organ donation after cardiac death: the story of Italy’s first experience. J Crit Care. 2017;38:129–31.

    Article  PubMed  Google Scholar 

  49. De Carlis R, Di Sandro S, Lauterio A, Botta F, Ferla F, Andorno E, Bagnardi V, De Carlis L. Liver grafts from donors after cardiac death on regional perfusion with extended warm ischemia compared with donors after brain death. Liver Transpl. 2018 [Epub ahead of print].

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Riccardo De Carlis, Paolo Aseni & Luciano De Carlis

  2. Department of Surgical Sciences, University of Pavia, Pavia, Italy

    Riccardo De Carlis

  3. Intensive Medicine Department, IRCCS Policlinico San Matteo, Pavia, Italy

    Marinella Zanierato & Giorgio Antonio Iotti

  4. School of Medicine, University of Milano-Bicocca, Milan, Italy

    Luciano De Carlis

Authors
  1. Riccardo De Carlis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marinella Zanierato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giorgio Antonio Iotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paolo Aseni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luciano De Carlis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Riccardo De Carlis .

Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Milano, Italy

    Paolo Aseni

  2. School of Medicine, University of Milano-Bicocca, Niguarda Hospital, Milan, Milano, Italy

    Luciano De Carlis

  3. Department of Cardiac Surgery, IRCCS MultiMedica, Milan, Milano, Italy

    Alessandro Mazzola

  4. Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

    Antonino M. Grande

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Cite this chapter

De Carlis, R., Zanierato, M., Iotti, G.A., Aseni, P., De Carlis, L. (2019). The Potential Organ Donor: Current Trends and Management. In: Aseni, P., De Carlis, L., Mazzola, A., Grande, A.M. (eds) Operative Techniques and Recent Advances in Acute Care and Emergency Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95114-0_55

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-95114-0_55

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-95113-3

  • Online ISBN: 978-3-319-95114-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation