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Donneurs décédés après arrêt cardiaque: mise au point

Non-heart-beating donors: State of the art

  • Enseignement Supérieur en Réanimation
  • Published:
Réanimation

Résumé

Dès 2005, face à l’inadéquation persistante entre les indications de greffe et le nombre de greffons disponibles, la France a mis en oeuvre un programme de prélèvements d’organes sur donneurs décédés après arrêt cardiaque (DDAC). Les DDAC regroupent deux entités distinctes: les prélèvements sur donneurs « contrôlés » et « non contrôlés ». Si dans les deux cas le coeur est non battant, les donneurs contrôlés sont des patients hospitalisés en réanimation pour lesquels une décision d’arrêt thérapeutique a été prise (Maastricht III), alors que les seconds sont des donneurs ayant fait un arrêt cardiaque inattendu, le plus souvent en dehors de l’hôpital, et pour lesquels une activité hémodynamique n’a pas pu être restaurée (Maastricht I et II). Si les premiers posent des difficultés éthiques évidentes, les seconds présentent une complexité technique et organisationnelle importante afin de limiter au maximum la durée de l’ischémie chaude. Les prélèvements de reins, de foies et de tissus sur donneurs non contrôlés sont les seuls autorisés en France. Pour minimiser les risques d’échec de greffe, les critères de sélection des donneurs et des receveurs et le respect des délais visant à limiter la durée de l’ischémie chaude sont drastiques. Dans ces conditions, les résultats obtenus sont comparables à ceux des donneurs en état de mal encéphalique.

Abstract

Due to persistent mismatch between transplant indications and available grafts, a transplantation program for non-heart-beating donors (NHBD) has been implemented in France since 2005. NHBD program includes two separate entities: “controlled” and “uncontrolled” NHBD. If in both cases, the heart is not beating, controlled NHBD are patients admitted in the intensive care unit and for whom a decision of treatment withdrawal was undertaken (Maastricht III); while uncontrolled NHBD are donors who experienced unexpected cardiac arrest, often out of the hospital, with no return of spontaneous activity (Maastricht I and II). Due to ethical concerns, controlled NHBD are not allowed in France. Organ retrieval from uncontrolled NHBD needs significant technical organization to minimize duration of warm ischemia. Only kidneys, liver, and tissues retrieval from “uncontrolled” NHBD are allowed in France. To minimize the risk of primary organ non-function, criteria for selection of donors and recipients as well as deadlines to limit duration of warm ischemia are restrictive. When all these criteria are respected, transplantation results are similar with organs obtained from NHBD and brain-dead donors.

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  1. Département d’anesthésie-réanimation, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, F-75010, Paris, France

    F. Fieux & L. Jacob

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  1. F. Fieux
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  2. L. Jacob
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Correspondence to F. Fieux.

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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2013 dans la session: Comment augmenter le nombre de greffons.

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Fieux, F., Jacob, L. Donneurs décédés après arrêt cardiaque: mise au point. Réanimation 22 (Suppl 2), 446–455 (2013). https://doi.org/10.1007/s13546-012-0624-4

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