Developing a DCD Liver Transplant Program

Abstract

With the significant risk of waitlist mortality in the end-stage liver disease population, donation after circulatory death (DCD) liver transplantation remains an important but underutilized source of deceased donor organs in many parts of the world. Committing to develop a DCD liver transplant program in many ways requires a reinvention of the liver transplant program itself. It requires strong but collaborative leadership, identification of program demand for DCD livers, and broad stakeholder engagement inside the hospital with transplant and non-transplant personnel. Additionally, protocols must be developed for recipient selection, donor acceptance criteria, and clinical management. A strong performance monitoring plan is necessary. Understanding the key principles discussed here may help DCD liver transplant programs provide wider access to liver transplantation to clinically vulnerable populations whose mortality risk is not well represented by their MELD score. In this chapter, we aim to review key principles that programs should consider in implementing a DCD liver transplant program. These key principles include: leadership and mentorship, team development and engagement, careful recipient selection, utilization of data-driven protocols, relationship management with organ procurement organizations and donor hospitals, and the use of clinical quality improvement techniques to push stepwise program maturation.