Current Neurology and Neuroscience Reports

, Volume 12, Issue 4, pp 456–465 | Cite as

Critical Care of the Potential Organ Donor

  • Anna J. Dare
  • Adam S. Bartlett
  • John F. Fraser
Critical Care (SA Mayer, Section Editor)


Organ transplantation represents one of the great success stories of 20th century medicine. However, its continued success is greatly limited by the shortage of donor organs. This has led to an increased focus within the critical care community on optimal identification and management of the potential organ donor. The multi-organ donor can represent one of the most complex intensive care patients, with numerous competing physiological priorities. However, appropriate management of the donor not only increases the number of organs that can be successfully donated but has long-term implications for the outcomes of multiple recipients. This review outlines current understandings of the physiological derangements seen in the organ donor and evaluates the available evidence for management strategies designed to optimize donation potential and organ recovery. Finally, emerging management strategies for the potential donor are discussed within the current ethical and legal frameworks permitting donation after both brain and circulatory death.


Brain death Organ donation Cytokine storm Hormone resuscitation Donation after circulatory death Donation after brain death Transplantation Critical care 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Langone A, Helderman J. Disparity between solid-organ supply and demand. NEJM. 2003;349:704–7.PubMedCrossRefGoogle Scholar
  2. 2.
    The Organ Procurement and Transplantation Network; Data. In: Editor (ed)^(eds) Book The Organ Procurement and Transplantation Network; Data. OPTN, City, pp.Google Scholar
  3. 3.
    Beecher H. A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205:337–40.CrossRefGoogle Scholar
  4. 4.
    Novitzsky D. Detrimental effects of brain death on the potential organ donor. Transplant Proc. 1997;29:3770–2.CrossRefGoogle Scholar
  5. 5.
    Vienenkoetter D, Esmaeilzadeh M, Unterberg A, Ahmadi R. Critical care management of potential organ donors: our current standard. Clin Transplant. 2009;23:2–9.PubMedGoogle Scholar
  6. 6.
    Non heart-beating organ transplantation: Practice and Protocols. In: Editor (ed)^(eds) Book Non heart-beating organ transplantation: Practice and Protocols. Institute of Medicine, City, pp. 174Google Scholar
  7. 7.
    Bernat J, D’Alessandro A, Port F, Bleck T, Heard S, Medina J, et al. Report of a national conference on donation after cardiac death. Am J Transplant. 2006;6:281–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Reich D, Mulligan P, Pruett T, Abecassis M, D’Alessandro A, Pomfret E, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation. Am J Transplant. 2009;9:2004–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Sanchez-Fructosis A, Prats D, Torrente J, Perez-Contin M, Fernandez C, Alvarez J, et al. Renal transplantation from non-heart beating donors: a promising alternative to enlarge the donor pool. J Am Soc Nephrol. 2000;11:350–8.Google Scholar
  10. 10.
    Kootstra G, Daemen J, Oomen A. Categories of non-heart-beating donors. Transplant Proc. 1995;27:2893–4.PubMedGoogle Scholar
  11. 11.
    Wilhelm M, Pratschke J, Laskowski I, Paz D, Tilney N. Brain death and its impact on the donor heart - lessons from animal models. J Heart Lung Transplant. 2000;19:414–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Shivalker B, van Loon J, Wieland W, Tjandra-Maga T, Borgers M, Plets C, et al. Variable effects of explosive or gradual increase of intracranial pressure on myocardial structure and function. Circulation. 1993;87:230–9.CrossRefGoogle Scholar
  13. 13.
    Novitzsky D, Horak A, Cooper D, Rose A. Electrocardiographic and histopathologic changes developing during experimental brain death in the baboon. Transplant Proc. 1989;21:2567–9.Google Scholar
  14. 14.
    Novitzsky D, Wicomb W, Cooper D. Electrocardiographic, haemodynamic and endocrine changes occurring during experimental brain death in the Chacma baboon. J Heart Transplant. 1984;4:63.Google Scholar
  15. 15.
    Power B, van Heerden P. The physiological changes associated with brain death - current concepts and implications for treatment of the brain dead donor. Anaesth Intensive Care. 1995;23:26–36.PubMedGoogle Scholar
  16. 16.
    Wood K, Becker B, McCartney J, D’Alessandro A, Coursin D. Care of the potential organ donor. NEJM. 2004;351:2730–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Wheeldon D, Potter C, Oduro A, Wallwork J, Large S. Transforming the “unacceptable” donor: outcomes from adoption of a standardized donor management technique. J Heart Lung Transplant. 1995;14:734–42.PubMedGoogle Scholar
  18. 18.
    Kutsogiannis D, Pagliarello G, Doig C, Ross H, Shemie S. Medical management to optimize donor organ potential: review of the literature. Can J Anesth. 2006;53:820–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Schnuelle P, Berger S, de Boer J, Persijn G, van der Woude F. Effects of catelcholamine application to brain-dead donors on graft survival in solid organ transplantation. Transplantation. 2001;72:455–63.PubMedCrossRefGoogle Scholar
  20. 20.
    Debaveye Y, van de Berghe G. Is there still a place for dopamine in the modern intensive care unit? Anaesth Analg. 2004;98:461–8.CrossRefGoogle Scholar
  21. 21.
    Finfer S, Bohn D, Colpitts D, Cox P, Fleming F, Barker G. Intensive care management of paediatric donor organs and its effect on post-transplant organ function. Intensive Care Med. 1996;22:1424–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Koning O, Ploeg R, van Bockel J, Groenewegen M, van der Woude F, Persijn G, et al. Risk factors for delayed graft function in cadaveric kidney transplantation: a prospective study of renal function and graft survival after preservation with University of Wisconsin solution in multi-organ donors. Transplantation. 1997;63:1620–8.PubMedCrossRefGoogle Scholar
  23. 23.
    •• Franklin G, Santos A, Smith J, Galbraith S, Harbrecht B, Garrison R, (2010) Optimization of Donor Management Goals yields increased organ use. The American Surgeon 76. The first data from a UNOS series prospectively evaluating the use of DMGs as end points for resuscitation in the organ donor. Provides interesting insight into which standard goals may be necessary for optimal organ use, namely PaO 2 , inotrope use, and glucose control, and which appear to have no effect. The full multiregional results evaluating the development and use of DMGs are awaited. Google Scholar
  24. 24.
    Katz K, Lawler J, Wax J, O’Connor R, Nadkarni V. Vasopressin pressor effects in critically ill children during evaluation for brain death and organ recovery. Resuscitation. 2000;47:33–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Pennefether S, Bullock R, Mantle D, Dark J. Use of low dose arginine vasopressin to support brain-dead organ donors. Transplantation. 1995;59:58–62.CrossRefGoogle Scholar
  26. 26.
    Hunt S, Baldwin J, Baumgartner W, Bricker J, Costanzo M, Miller L, et al. Cardiovascular management of a potential heart donor: a statement from the Transplantation Committee of the American College of Cardiology. Crit Care Med. 1996;24:1599–601.PubMedCrossRefGoogle Scholar
  27. 27.
    Iwai A, Sakano T, Uenishi M, Sugimoto H, Yoshioko T, Sugimoto T. Effect of vasopressin and catecholamines on the maintenance of stability in brain dead patients. Transplantation. 1989;48:613–7.PubMedGoogle Scholar
  28. 28.
    Van Raemdonck D, Neyrinck A, Verleden G, Dupont L, Coosemans W, Decauwe H. Lung donor selection and management. Proc Am Thorac Soc. 2009;6:28–38.PubMedCrossRefGoogle Scholar
  29. 29.
    Hornby K, Ross H, Keshavjee S, Rao V, Shemie S. Non-utilisation of hearts and lungs after consent for donation: a Canadian multi-centre study. Can J Anaesth. 2006;53:831–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Angel L, Levine D, Restrepo M, Johnson S, Sako E, Carpenter A, et al. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes. Am J Respir Crit Care Med. 2006;174:710–6.PubMedCrossRefGoogle Scholar
  31. 31.
    • Mascia L, Pasero D, Slutsky A, Arguis M, Grasso S, Munari M, Boifava S, Cornara G, Della Corte F, Vivaldi N, Malacarne P, Del Gaudio P, Livigni S, Zavala E, Filippini C, Martin E, Donadio P, Mastromauro I, Ranieri V, (2010) Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation. JAMA 304: 2620–2627. Lungs remain one of the most difficult organs to maintain donation potential in after brainstem death. This multicenter RCT demonstrates that institution of a lung-protective ventilatory strategy in potential organ donors significantly increased the number of eligible and transplanted lungs compared to conventional ventilatory strategies. PubMedCrossRefGoogle Scholar
  32. 32.
    Bittner H, Kendall S, Chen E, Craig D, Van Trigt P. The effects of brain death on cardiopulmonary hemodynamics and pulmonary bloodflow characteristics. Chest. 1995;108:1358–63.PubMedCrossRefGoogle Scholar
  33. 33.
    Novitzsky D, Wicomb W, Rose A, Cooper D, Reichart B. Pathophysiology of pulmonary oedema following experimental brain death in the Chacma baboon. Ann Thorac Surg. 1987;43:288–94.CrossRefGoogle Scholar
  34. 34.
    van der Zee H, Malik A, Lee B, Hakim T. Lung fluid and protein exchange during intracranial hypertension and role of sympathetic mechanisms. Ann Thorac Surg. 1987;48:273–80.Google Scholar
  35. 35.
    Fisher A, Donnelly S, Hirani N, Burdick M, Strieter R, Dark J, et al. Enhanced pulmonary inflammation in organ donors following fatal non-traumatic brain injury. Lancet. 1999;353:1412–3.PubMedCrossRefGoogle Scholar
  36. 36.
    Fisher A, Donelly S, Hirani N, Haslett C, Strieter R, Dark J, et al. Elevated levels of interleukin-8 in donor lungs is associated with early graft failure after lung transplantation. Am J Respir Crit Care Med. 2001;163:259–65.PubMedGoogle Scholar
  37. 37.
    Neyrinck A, Van de Wauwer C, Geudens N, Rega F, Verleden G, Wouters P, et al. Comparative study of donor lung injury in heart-beating versus non-heart beating donors. Eur J Cardiothorac Surg. 2006;30:628–36.PubMedCrossRefGoogle Scholar
  38. 38.
    Kang C, Anraku M, Cypel M, Sato M, Yeung J, Gharib S, et al. Transcriptional signatures in donor lungs from donation after cardiac death vs after brain death: a functional pathway analysis. J Heart Lung Transplant. 2011;30:289–98.PubMedCrossRefGoogle Scholar
  39. 39.
    Avlonitis V, Fisher A, Kirby J, Dark J. Pulmonary transplantation: the role of brain death in donor lung injury. Transplantation. 2003;75:1928–33.PubMedCrossRefGoogle Scholar
  40. 40.
    Gabbay E, Williams T, Griffiths A, Macfarlane L, Kotsimbos T, Esmore D, et al. Maximising the utilization of donor organs offered for lung transplantation. Am J Resp Crit Care Med. 1999;160:265–71.PubMedGoogle Scholar
  41. 41.
    Mascia L, Bosma K, Pasero D, Galli T, Cortese G, Donadio P, et al. Ventilatory and hemodynamic management of potential organ donors: an observational study. Crit Care Med. 2006;34:321–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Botha P, Rostron A, Fisher A, Dark J. Current strategies in donor selection and management. Semin Thorac Cardiovasc Surg. 2008;20:143–51.PubMedCrossRefGoogle Scholar
  43. 43.
    Noiseux N, Nguyen B, Marsolais P, Dupont J, Simard L, Houde I, et al. Pulmonary recruitment protocol for organ donors: a new strategy to improve rate of lung utilisation. Transplant Proc. 2009;41:3284–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Ware L, Fang X, Wang Y, Sakuma T, Hall T, Matthay M. Selected contribution: mechanisms that may stimulate the resolution of alveolar edema in the transplanted human lung. J Appl Physiol. 2002;93:1869–74.PubMedGoogle Scholar
  45. 45.
    Neyrinck A, Rega F, Fransen L, De Winter H, Jannis N, Wouters P, et al. b-adrenergic stimulation of alveolar liquid clearance: a novel strategy to resolve pulmonary edema after lung transplantation? (Abstract). Eur J Anaesthesiol. 2004;21:A664.CrossRefGoogle Scholar
  46. 46.
    • Ware L, Koyama T, Billheimer D, Landeck M, Johnson E, Brady S, Bernard G, Matthay M, (2011) Advancing donor management research: design and implentation of a large, randomized, placebo-controlled trial. Annals of Intensive Care 1. Evaluates the logistical challenges of conducting RCTs in the setting of organ donor management, based on the group’s personal experiences with instigating one of the few placebo-controlled RCTs in this field. Given the need to improve the quality of evidence pertaining to the management of the potential organ donor this is an important paper both for investigators planning future clinical trials in the brain-dead donor population and for intensivists who are involved in the care of the brain-dead organ donors and in the design and conduct of research in this field. Google Scholar
  47. 47.
    Folkesson H, Norlin A, Wang Y, Abedinpour P, Matthay M. Dexamethasone and thyroid hormone pre-treatment upregulate alveloar epithelial fluid clearance in adult rats. J Appl Physiol. 2000;88:416–24.PubMedCrossRefGoogle Scholar
  48. 48.
    Mukadam M, Harrington D, Wilson I, Mascaro J, Rooney S, Thompson R, et al. Does donor catelcholamine administration effect early lung function after transplantation? J Thorac Cardiovasc Surg. 2005;130:926–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Cooper D, Novitzsky D, Wicomb W. The pathophysiological effects of brain death on potential donor organs, with particular reference to the heart. Ann R Coll Surg Engl. 1989;71:261–6.PubMedGoogle Scholar
  50. 50.
    Wicomb W, Cooper D, Lanza R, Novitzsky D, Isaacs S. Storage by hypothermic perfusion on donor heart function in the pig. J Thorac Cardiovasc Surg. 1986;91:896–909.PubMedGoogle Scholar
  51. 51.
    Dictus C, Vienenkoetter B, Esmaeilzadeh M, Unterberg A, Ahmadi R. Critical care management of potential organ donors: our current standard. Clin Transplant. 2009;23:2–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Novitzsky D, Cooper D, Rosendale J, Kauffman H. Hormonal therapy of the brain-dead organ donor: experimental and clinical studies. Transplantation. 2006;82:1396–401.CrossRefGoogle Scholar
  53. 53.
    Rosendale J, Kauffman H, McBride M, Chabalewski F, Zaroff J, Garrity E, et al. Hormonal resuscitation yields more transplanted hearts with improved early function. Transplantation. 2003;75:1336–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Holmes C, Patel B, Russell J, Walley K. Physiology of vasopressin relevant to management of septic shock. Chest. 2001;120:989–1002.PubMedCrossRefGoogle Scholar
  55. 55.
    Figueras J, Busquets J, Grande L, Jaurrieta E, Perez-Ferreiroa J, Mir J, et al. The deleterious effect of donor high plasma sodium and extended preservation in liver transplantation. A multivariate analysis. Transplantation. 1996;61:410–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Avolio A, Agnes S, Magalini S, Foco M, Castagneto M. Importance of donor blood chemistry data (AST, serum sodium) in predicting liver transplant outcome. Transplant Proc. 1991;23:2451–2.PubMedGoogle Scholar
  57. 57.
    Gonzalez F, Rimmola A, Grande L, Antolin M, Garcia-Valdecasas J, Fuster J, et al. Predictive factors of early postoperative graft function in human liver transplantation. Hepatology. 1994;20:565–73.PubMedGoogle Scholar
  58. 58.
    Totsuka E, Dodson F, Urakami A, Moras N, Ishii T, Lee M, et al. Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia. Liver Transpl Surg. 1999;5:421–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Mangus R, Fridell J, Vianna R, Milgrom M, Chestovich P, Vandenboom C, et al. Severe hypernatremia in deceased liver donors does not impact early transplant outcome. Transplantation. 2010;90:438–43.PubMedCrossRefGoogle Scholar
  60. 60.
    Tector A, Mangus R, Chestovich P, Vianna R, Fridell J, Milgrom M, et al. Use of extended criteria livers decrease wait time for liver transplantation without adversely impacting posttransplant survival. Ann Surg. 2006;244:439–50.PubMedGoogle Scholar
  61. 61.
    Tekin K, Imber C, Atli M, Gunson B, Bramhall S, Mayer D, et al. A simple scoring system to evaluate the effects of cold ischemia on marginal liver donors. Transplantation. 2004;77:411–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Renz J, Kin C, Kinkhabwala M, Jan D, Varadarajan R, Goldstein M, et al. Utilization of extended donor criteria liver allografts maximises donor use and patient access to liver transplantation. Ann Surg. 2005;242:556–63.PubMedGoogle Scholar
  63. 63.
    Rosendale J, Kauffman H, McBride M, Chabalewski F, Zaroff J, Garrity E, et al. Aggressive pharmacological donor management results in more transplanted organs. Transplantation. 2003;75:482–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Masson F, Thicoipe M, Gin H, De Mascarela A, Angibeau R, Favarel-Garrigues J, et al. The endocrine pancreas in brain-dead donors. Transplantation. 1993;56:363–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Gores P, Gillingham K, Dunn D, Moudry-Munns K, Najarian J, Sutherland D. Donor hyperglycaemia as a minor risk factor and immunologic variables as major risk factors for pancreas allograft loss in a multivariate analysis of a single institution’s experience. Ann Surg. 1992;215:217–30.PubMedCrossRefGoogle Scholar
  66. 66.
    Smith M. Physiologic changes during brainstem death: lessons for management of the organ donor. J Heart Lung Transplant. 2004;23:S217–22.PubMedCrossRefGoogle Scholar
  67. 67.
    Cipolla J, Stawicki S, Spatz D. Haemodynamic monitoring of organ donors: a novel use of the oesophageal echo-Doppler probe. Am Surg. 2006;72:500–4.PubMedGoogle Scholar
  68. 68.
    Uchino S, Bellomo R, Morimatsu H, Sugihara M, French C, Stephens D, et al. Pulmonary artery catheter versus pulse contour analysis: a prospective epidemiological study. Crit Care. 2006;10:R174.PubMedCrossRefGoogle Scholar
  69. 69.
    Jenkins D, Reilly P, Schwab C. Improving the approach to organ donation: a review. World J Surg. 1999;23:644–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Lopez-Navidad A, Caballero F. For a rational approach to the critical points of the cadaveric donation process. Transplant Proc. 2001;33:795–805.PubMedCrossRefGoogle Scholar
  71. 71.
    Grossman M, Reilly P, McMahon D, (1996) Loss of potential organ donors due to medical failure. Crit Care Med 24Google Scholar
  72. 72.
    Hagan M, McClean D, Falcone C, Arrington J, Matthews D, Summe C. Attaining specific donor management goals increases number of organs transplanted per donor: a quality improvement project. Prog Transplant. 2009;19:227–31.PubMedGoogle Scholar
  73. 73.
    Santisea G, D’Anconaa G, Fallettab C, Pironea F, Sciaccaa S, Turrisia M, et al. Donor pharmacological hemodynamic support is associated with primary graft failure in human heart transplantation. Interact Cardiovasc Thorac Surg. 2009;9:476–9.CrossRefGoogle Scholar
  74. 74.
    Reilly P, Morgan L, Grossman M, Shapiro M, Anderson H, Hawthorne R, Schwab C, Lung procurement from solid organ donors: role of fluid resuscitation in procurement failures. The Internet Journal of Emergency and Intensive Care Medicine. 1999;3Google Scholar
  75. 75.
    Kunzendorf U, Hohenstein B, Oberbarnscheid M, Muller E, Renders L, Schott G, et al. Duration of donor brain death and its influence on kidney graft function. Am J Transplant. 2002;2:292–4.PubMedCrossRefGoogle Scholar
  76. 76.
    Lopez-Navidad A, Domingo P, Caballero F. Organ shortage: viability of potential organ donors and possible loss depend on health care workers who are responsible for the organ procurement program. Transplant Proc. 1997;29:3614–6.PubMedCrossRefGoogle Scholar
  77. 77.
    •• Kootstra G (2009) History of non-heart beating donation. In: Talbot D, D’Alessandro A (eds) Organ donation and transplantation after cardiac death. Oxford University Press, Oxford. Written by a team of international experts, this book provides a detailed and comprehensive overview of both the basic science and the clinical evidence currently available that has underpinned the development of DCD protocols in the UK and Europe. It also provides an outline of the moral, legal, and ethical considerations in the development of DCD programs. It is probably the most considered and authorative overview of DCD to date. Google Scholar
  78. 78.
    Shemie S, De Vita M. Legal, moral and ethical issues. In: Talbot D, D’Alessandro A, editors. Organ donation and transplantation after cardiac death. Oxford: Oxford University Press; 2009.Google Scholar
  79. 79.
    Ethics Committee, American College of Critical Care Medicine; Society of Critical Care Medicine. Recommendations for nonheart-beating organ donation. A position paper by the Ethics Committee, American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med. 2001;29:1826–31.CrossRefGoogle Scholar
  80. 80.
    United Network of Organ Sharing. Donation after cardiac death; A reference guide. UNOS, Richmond, VAGoogle Scholar
  81. 81.
    Rubenstein S, (2008) Caifornia surgeon cleared of hastening organ donor’s death. The Wall Street JGoogle Scholar
  82. 82.
    Lewis J, Peltier J, Nelson H, Snyder W, Schneider K, Steinberger D, et al. Development of th University of Wisconsin donation after cardiac death evaluation tool. Prog Transplant. 2003;13:265–73.PubMedGoogle Scholar
  83. 83.
    Lee K, Simpkins C, Montgomery R, Locke J, Segev D, Maley W. Factors affecting graft survival after liver transplantation from donation after cardiac death donors. Transplantation. 2006;82:1683–8.PubMedCrossRefGoogle Scholar
  84. 84.
    Fernandez L, Di Carlo A, Odorico J, Leverson G, Shames B, Becker Y, et al. Simultaneous pancreas-kidney transplantation from donation after cardiac death: successful long term outcomes. Ann Surg. 2005;242:732–8.CrossRefGoogle Scholar
  85. 85.
    DeVita M, Brooks M, Zawistowski C, Rudich S, Daly B, Chaitin E. Donors after Cardiac Death: Validation of identification Criteria (DVIC) study for predictors of rapid death. Am J Transp. 2008;8:432–41.CrossRefGoogle Scholar
  86. 86.
    Herdman R, Beauchamp T, Potts J. The Institute of Medicine’s report on non-heart beating organ transplantation. Kennedy Inst Ethics. 1998;8:83–90.CrossRefGoogle Scholar
  87. 87.
    Casavilla A, Ramirez CS R, Nghiem D, Miracle J, Fung J, Starzl T. Experience with liver and kidney allografts from non heart beating donors. Transplant Proc. 1995;27:2898.PubMedGoogle Scholar
  88. 88.
    Veatch R. Transplantation Ethics. Washington: Georgetown University Press; 2000.Google Scholar
  89. 89.
    Koffman G, Gambaro G. Renal transplantation from non-heart beating donors: a review of the European experience. J Nephrol. 2003;16:334–41.PubMedGoogle Scholar
  90. 90.
    Shemie S, Baker A, Knoll G, Wall W, Rocker G, Howes D. Donation after cardiocirculatory death in Canada. CMAJ. 2006;175:S1–S24.PubMedCrossRefGoogle Scholar
  91. 91.
    Organ donation: opportunities for action. In: Editor (ed)^(eds) Book Organ donation: opportunities for action. Institution of Medicine, City, pp. 358Google Scholar
  92. 92.
    Punch J (2009) Extracorporeal circulatory-assisted non heart beating organ donation. In: Talbot D, D'Alessandro A (eds) Organ donation and transplantation after cardiac death. Oxford University PressGoogle Scholar
  93. 93.
    Magliocca J, Magee J, Rowe S, Gravel M, Chenault R, Merion R, et al. Extracorporeal support for organ donation after cardiac death effectively expands the donor pool. J Trauma. 2005;58:1095–102.PubMedCrossRefGoogle Scholar
  94. 94.
    Ko W, Chen Y, Tsai P, Lee P. Extracorporeal membrane oxygenation support of donor abdominal organs in non-heart beating donors. Clin Transplant. 2000;14:152–6.PubMedCrossRefGoogle Scholar
  95. 95.
    Gravel M, Arenas J, Chenault R, Magee J, Rudich S, Maraschio M, et al. Kidney transplantation from organ donors following cardiopulmonary death using extracorporeal membrane oxygenation support. Am J Transplant. 2004;9:57–8.Google Scholar
  96. 96.
    Fondevila C, Hessheimer A, Ruiz A, Calatayud D, Ferrer J, Charco R, et al. Liver transplant using donors after unexpected cardiac death: Novel preservation protocol and acceptance criteria. Am J Transplant. 2007;7:1849–55.PubMedCrossRefGoogle Scholar
  97. 97.
    • Bernat J, Capron A, Bleck T, Blosser S, Bratton S, Childress J, DeVita M, Fulda G, Gries C, Mathur M, Nakagawa T, Rushton C, Shemie S, White D, (2010) The circulatory-respiratory determination of death in organ donation. Crit Care Med 38: 963–970. This paper represents the report of an interdisciplinary panel convened by the Health Resources and Services Administration, Division of Transplantation in the US, on the role and means of death determination using circulatory-repsiratory tests, with particular reference to the use of postmortem ECMO to support donor organs and the transplantation of hearts. This report outlines many of the key ethical and technical issues and controversies associated with advancing management of the DCD donor. PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Anna J. Dare
    • 1
  • Adam S. Bartlett
    • 1
  • John F. Fraser
    • 2
  1. 1.Department of Surgery, Auckland City HospitalUniversity of Auckland & New Zealand Liver Transplant UnitGraftonNew Zealand
  2. 2.Critical Care Research GroupThe Prince Charles HospitalBrisbaneAustralia

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