A Step toward Standardization: Results of two National Surveys of Best Practices in Donation after Circulatory Death Liver Recovery and Recommendations from The American Society of Transplant Surgeons and Association of Organ Procurement Organizations.

Donation after circulatory death (DCD) liver allografts remain underutilized. Inconsistent processes for DCD procurement may contribute to allograft discard. Optimal surgical and organ procurement organization (OPO) practices for DCD liver recovery should be developed and adopted. DCD practice surveys were distributed to transplant surgeons and OPO leadership. DCD liver recovery best practices were assembled based on survey data, literature review, and subject-matter expert consensus opinion. Data were obtained from transplant surgeons (n = 188) and OPO leadership (n = 48 OPOs). Surgeons preferred attending physician presence at recovery (72.4%); while only 27.7% of OPOs require this. Pre-withdrawal communication huddle (Surgeons: 88.7%; OPOs: 93.8%) and administration of pre-withdrawal heparin (Surgeons: 90.6%; OPOs: 84.8%) are widely accepted. Surgical preference for withdrawal of support is in the operating room (89.3%); OPO practice varies dependent upon hospital and family requirements. Functional donor warm ischemic time (fDWIT) start time is variable, while fDWIT end time is agreed upon as initiation of aortic flush by surgeons (81%) and OPOs (81%). DCD liver recovery practices including mandatory communication huddle, pre-withdrawal heparin administration, and clearly defined start and end of fDWIT should be implemented nationally. Creating a set of best practices for DCD recovery guidelines is necessary for improving DCD liver utilization.

Donor Age, Sex, and Cause of Death and Their Relationship to Heart Transplant Recipient Cardiac Death.

BACKGROUND: Recent studies indicate that donor innate immune responses participate in initiating and accelerating innate responses and allorecognition in the recipient. These immune responses negatively affect recipient outcomes and predispose recipients to cardiovascular death (CV death). We hypothesized that a donor cause of death (COD) associated with higher levels of innate immune response would predispose recipients to more adverse outcomes post-transplant, including CV death. METHODS: We performed a single-institution retrospective analysis comparing donor characteristics and COD to recipient adverse cardiovascular outcomes. We analyzed the medical records of local adult donors (age 18-64) in a database of donors where adequate data was available. Donor age was available on 706 donors; donor sex was available on 730 donors. We linked donor characteristics (age and sex) and COD to recipient CV death. The data were analyzed using logistic regression, the log-rank test of differences, and Tukey contrast. RESULTS: Donor age, female sex, and COD of intracranial hemorrhage were significantly associated with a higher incidence of recipient CV death. CONCLUSIONS: In this single institution study, we found that recipients with hearts from donors over 40 years, donors who were female, or donors who died with a COD of intracranial hemorrhage had a higher frequency of CV death. Donor monitoring and potential treatment of innate immune activation may decrease subsequent recipient innate responses and allorecognition stimulated by donor-derived inflammatory signaling, which leads to adverse outcomes.