Changing Patterns of Organ Donation: Brain Dead Donors Are Not Being Lost by Donation After Circulatory Death.

The clinical characteristics of all New England Organ Bank (NEOB) donors after circulatory death (DCD) donors were analyzed between July 1, 2009, and June 30, 2014. During that 5-year period, there were 494 authorized medically suitable potential DCDs that the NEOB evaluated, constituting more than 30% of deceased donors coordinated annually by the NEOB. From the cohort of 494 authorized potential DCDs, 331 (67%) became actual DCD, 82 (17%) were attempted as a DCD but did not progress to donation, and 81 (16%) transitioned to an actual donor after brain death (DBD). Two hundred seventy-six organs were transplanted from the 81 donors that transitioned from DCD to actual DBD, including 24 heart, 70 liver, 12 single and 14 bilateral lung, and 12 pancreas transplants. When patients with devastating brain injury admitted to the intensive care units are registered donors, the Organ Procurement Organization staff should share the patient's donation decision with the health care team and the patient's family, as early as possible after the comfort measures only discussion has been initiated. The experience of the NEOB becomes an important reference of the successful implementation of DCD that enables an expansion of deceased donation (inclusive of DBD).

Successful Recovery and Transplantation of 11 Organs Including Face, Bilateral Upper Extremities, and Thoracic and Abdominal Organs From a Single Deceased Organ Donor.

We report on the to date largest recovery of 11 organs from a single deceased donor with the transplantation of face, bilateral upper extremities, heart, 1 lung, liver (split for 2 recipients), kidneys, pancreas, and intestine. Although logistically challenging, this case demonstrates the feasibility and safety of the recovery of multiple thoracic and abdominal organs with multiple vascular composite allotransplants and tissues. Our experience of 8 additional successful multiple vascular composite allotransplants, thoracic, and abdominal organ recoveries suggests that such procedures are readily accomplishable from the same deceased donor.

Donation after cardiac death: two case studies.

Few transplant centers consider using lungs from cardiac death donors because of warm ischemic damage. In certain scenarios, the recovery and transplantation of lungs from cardiac death donors are appropriate. A young person with a severe neurologic and spinal cord injury, who is not brain dead and who is otherwise healthy, should be considered as a cardiac death donor. A protocol should be established with local lung transplant surgeons to facilitate the successful procurement of lungs from cardiac death donors. In addition, when patients present to hospital emergency rooms with nonsurvivable injuries either in cardiac arrest or with extremely labile vital signs, uncontrolled donation after cardiac death can be considered. It is important to obtain informed consent from the family and to suspend any previous do-not-resuscitate orders before initiating resuscitative efforts. If an organ procurement coordinator and team are within close proximity to the hospital, consideration should be given to uncontrolled donation after cardiac death.