Non-Heart-Beating Donors

  • Antonino M. GrandeEmail author
  • Carlo Pellegrini


Since the dawn of transplantation organs have been retrieved from patients immediately after circulatory arrest, specifically from “non-heart-beating” donors. When the Harvard Medical Committee in 1968 defined the concept and the diagnostic criteria of brain-death, organ retrieval began to be performed in patients whose death was ascertained after brainstem testing. These “heart-beating” donors have become the main source of organs for transplantation. However, the number of heart-beating donors is now declining because fewer young people are dying from severe head trauma or catastrophic cerebrovascular events and the diagnosis and management of brain injuries have improved. Therefore, the scarcity of donor organs is the primary limiting factor of transplantation worldwide, and this condition causes an increased time span between listing and transplantation and prevents the death rate on the waiting list from improving. For this reason, selection criteria for organ donors have changed, and grafts from “marginal donors” have been used. These are older than optimal donors or present mild to moderate grade of organ dysfunction (such as diabetes mellitus, hypertension, renal insufficiency) or may transmit infectious diseases (CMV or HCV hepatitis). However, “marginal donors” do not affect outcomes in selected cases. Finally, the constantly increasing gap between donors and patients on waiting lists has prompted donation after circulatory death (DCD) or “non-heart-beating donors” (NHBDs). ECMO has been increasingly used in patients with acute cardiac failure and in patients after cardiac arrest, both in and out of the hospital. Mechanical circulatory support with ECMO may prevent loss of organs through haemodynamic stabilization of donor. DCD donors are usually identified according to Maastricht classification based on the circumstances of death and, consequently, the warm ischemic time. ECMO techniques must be further studied to ameliorate graft survival and transplantation outcome.


Warm Ischemia Delay Graft Function Warm Ischemic Time Mechanical Circulatory Support Arterial Cannula 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death (1968) JAMA 205:337–340Google Scholar
  2. 2.
    Death rate trends for RTAs and CVAs, WHO European Health for All database –
  3. 3.
    Lee JH, Hong SY, Oh CK, Hong YS, Yim H (2012) Kidney transplantation from a donor following cardiac death supported with extracorporeal membrane oxygenation. J Korean Med Sci 27:115–119CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    DuBose J, Salim A (2008) Aggressive organs donor management protocol. J Intensive Care Med 23:367CrossRefPubMedGoogle Scholar
  5. 5.
    Deakin CD, Nolan JP, Soar J et al (2010) European Resuscitation Council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation 81:1305–1352CrossRefPubMedGoogle Scholar
  6. 6.
    Massetti M, Gaudino M, De Paulis S, Scapigliati A, Cavaliere F (2014) Extracorporeal membrane oxygenation for resuscitation and cardiac arrest management. Heart Fail Clin 10:S85–S93CrossRefPubMedGoogle Scholar
  7. 7.
    Isnardi DI, Olivero F, Lerda R, Guermani A, Cornara G (2013) Extracorporeal membrane oxygenation as a bridge to organ donation: a case report. Transplant Proc 45:2619–2620CrossRefPubMedGoogle Scholar
  8. 8.
    Ke H-Y, Lin C-Y, Tsai Y-T, Lee C-H, Hong G-C, Lee C-H, Tsai C-S (2010) Increase the donor pool: transportation of a patient with fatal head injury supported with extracorporeal membrane oxygenation. J Trauma 68:E87–E88CrossRefPubMedGoogle Scholar
  9. 9.
    Kootstra G, Daemen JHC, Oomen APA (1995) Categories of non-heart beating donors. Transplant Proc 27:2893–2895PubMedGoogle Scholar
  10. 10.
    Bellingham JM, Santhanakrishnan C, Neidlinger N et al (2011) Donation after cardiac death: a 29-year experience. Surgery 150:692CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Halazun KJ, Al-Mukhtar A, Willis S, Ahmad N (2007) Warm ischemia in transplantation: search for a consensus definition. Transplant Proc 39:1329–1331CrossRefPubMedGoogle Scholar
  12. 12.
    Garcia-Rinaldi R, Lefrak EA, Defore WW et al (1975) In situ preservation of cadaver kidneys for transplantation: laboratory observations and clinical application. Ann Surg 182:576–584CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Perico N, Cattaneo D, Sayegh MH, Remuzzi G (2004) Delayed graft function in kidney transplantation. Lancet 364:1814–1827CrossRefPubMedGoogle Scholar
  14. 14.
    Wijnen RM, Booster MH, Stubenitsky BM et al (1995) Outcome of transplantation of non heart-beating donor kidneys. Lancet 345:1067–1070CrossRefPubMedGoogle Scholar
  15. 15.
    Yarlagadda SG, Coca SG, Formica RN Jr et al (2009) Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. Nephrol Dial Transplant 24:1039–1047CrossRefPubMedGoogle Scholar
  16. 16.
    Nicholson ML, Hosgood SA (2013) Renal transplantation after ex vivo normothermic perfusion: the first clinical study. Am J Transplant 13:1246CrossRefPubMedGoogle Scholar
  17. 17.
    Cypel M, Yeung JC, Machuca T et al (2012) Experience with the first 50 ex vivo lung perfusions in clinical transplantation. J Thorac Cardiovasc Surg 144:1200CrossRefPubMedGoogle Scholar
  18. 18.
    Fukushima N, Sakagoshi N, Ohtake S, Sawa Y, Kawata H, Shirakura R et al (2002) Effects of exogenous adrenaline on the number of the beta-adrenergic receptors after brain death in humans. Transplant Proc 34:2571–2574CrossRefPubMedGoogle Scholar
  19. 19.
    Arias-Díaz J, Álvarez JM, Gómez M, Del Barrio R, García-Carreras C, González P, Balibrea JL (1997) Changes in adenine nucleotides and lipid hydroperoxides during normothermic cardiopulmonary bypass in a porcine model of type II non-heart-beating donor. Transplant Proc 29:3486–3487CrossRefPubMedGoogle Scholar
  20. 20.
    Net M, Valero R, Almenara R, Barros P, Capdevilla L, Lopez-oado MA, Ruiz A et al (2005) The effect of normothermic recirculation is mediated by ischemic preconditioning in NHBD liver transplantation. Am J Transplant 5:2385CrossRefPubMedGoogle Scholar
  21. 21.
    García-Valdecasas JC, Tabet J, Valero R, Taurá P, Rull R, García F, Montserrat E et al (1998) Liver conditioning after cardiac arrest: the use of normothermic recirculation in an experimental animal model. Transpl Int 11:424–432CrossRefPubMedGoogle Scholar
  22. 22.
    Koyama I, Hoshino T, Nagashima N, Adachi H, Ueda K, Omoto R (1989) A new approach to kidney procurement from non-heart-beating donors: core cooling on cardiopulmonary bypass. Transplant Proc 21:1203–1205PubMedGoogle Scholar
  23. 23.
    Barrou B, Billault C, Nicolas-Robin A (2013) The use of extracorporeal membranous oxygenation in donors after cardiac death. Curr Opin Organ Transplant 18:148–153CrossRefPubMedGoogle Scholar
  24. 24.
    Valero R, Cabrer C, Oppenheimer F et al (2000) Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors. Transpl Int 13:303–310CrossRefPubMedGoogle Scholar
  25. 25.
    Sanchez-Fructuoso AI, Prats D, Torrente J et al (2000) Renal transplantation from non-heart beating donors: a promising alternative to enlarge the donor pool. J Am Soc Nephrol 11:350–358PubMedGoogle Scholar
  26. 26.
    Sanchez-Fructuoso AI, de Miguel Marques M, Prats D, Barrientos A (2003) Non-heart-beating donors: experience from the Hospital Clinico of Madrid. J Nephrol 16:387–392PubMedGoogle Scholar
  27. 27.
    Sanchez-Fructuoso AI, Marques M, Prats D et al (2006) Victims of cardiac arrest occurring outside the hospital: a source of transplantable kidneys. Ann Intern Med 145:157–164CrossRefPubMedGoogle Scholar
  28. 28.
    Reznik O, Skvortsov A, Loginov I et al (2011) Kidney from uncontrolled donors after cardiac death with one hour warm ischemic time: resuscitation by extracorporeal normothermic abdominal perfusion ‘in situ’ by leukocytes-free oxygenated blood. Clin Transplant 25:511–516CrossRefPubMedGoogle Scholar
  29. 29.
    Lee CY, Tsai MK, Ko WJ et al (2005) Expanding the donor pool: use of renal transplants from non-heart-beating donors supported with extracorporeal membrane oxygenation. Clin Transplant 19:383–390CrossRefPubMedGoogle Scholar
  30. 30.
    Chen KH, Tsai MK, Ko WJ et al (2000) Renal transplantation from non-heart-beating donors with extracorporeal membrane oxygenation: preliminary results. Transplant Proc 32:1743–1744CrossRefPubMedGoogle Scholar
  31. 31.
    Ko WJ, Chen YS, Chen RJ et al (2002) Non-heart-beating donors under extracorporeal membrane oxygenation support. Transplant Proc 34:2600–2601CrossRefPubMedGoogle Scholar
  32. 32.
    Farney AC, Hines MH, al-Geizawi S et al (2011) Lessons learned from a single center’s experience with 134 donations after cardiac death donor kidney transplants. J Am Coll Surg 212:440–451; discussion 451–453CrossRefPubMedGoogle Scholar
  33. 33.
    Gravel MT, Arenas JD, Chenault R 2nd et al (2004) Kidney transplantation from organ donors following cardiopulmonary death using extracorporeal membrane oxygenation support. Ann Transplant 9:57–58PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Cardiac SurgeryIRCCS Fondazione Policlinico San MatteoPaviaItaly

Personalised recommendations