Uncontrolled donation after circulatory death (uDCD) donors suffer sudden and unanticipated cardiac arrest, typically outside the hospital setting. After cardiopulmonary resuscitation has been attempted and determined to be unsuccessful according to current advanced life support standards, uDCD may be considered. At present, all programs recovering and transplanting uDCD livers rely on post-mortem abdominal normothermic regional perfusion (A-NRP), which restores the flow of oxygenated blood to the abdominal region following declaration of death. In this chapter, we discuss different aspects related to uDCD liver transplantation, including logistical and ethical issues surrounding the uDCD process, the use of A-NRP, graft and recipient selection, perioperative recipient management, and post-transplant outcomes that have been reported. We aim to demonstrate that, while uDCD is complex and the yield of livers for transplantation remains relatively low, it is nonetheless a viable alternative to more standard forms of liver donation.

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DCD Liver Transplantation from Uncontrolled Donors

  • Amelia J. Hessheimer,
  • Jordi Vengohechea,
  • Belen Estébanez,
  • Constantino Fondevila

摘要

Uncontrolled donation after circulatory death (uDCD) donors suffer sudden and unanticipated cardiac arrest, typically outside the hospital setting. After cardiopulmonary resuscitation has been attempted and determined to be unsuccessful according to current advanced life support standards, uDCD may be considered. At present, all programs recovering and transplanting uDCD livers rely on post-mortem abdominal normothermic regional perfusion (A-NRP), which restores the flow of oxygenated blood to the abdominal region following declaration of death. In this chapter, we discuss different aspects related to uDCD liver transplantation, including logistical and ethical issues surrounding the uDCD process, the use of A-NRP, graft and recipient selection, perioperative recipient management, and post-transplant outcomes that have been reported. We aim to demonstrate that, while uDCD is complex and the yield of livers for transplantation remains relatively low, it is nonetheless a viable alternative to more standard forms of liver donation.