Organ donation after circulatory death in Switzerland: slow but constant progress

Worldwide, the number of patients wait-listed for organ transplantation is growing. In most countries, however, there is a shortage of donor organs. Switzerland has one of the lowest post mortem donation rates among European countries. While most organs donated for transplantation are retrieved from primary or secondary brain-dead donors with sustained circulation (heart-beating donors), organ donation after circulatory determination of death (DCD or non-heart-beating donors) is increasingly accepted to partly compensate for the general shortage of organs suitable for transplantation in many countries. This is the case especially regarding kidney transplantation, where waiting lists are long and transplantations with standard-criteria DCD kidneys can increase the survival of patients with end stage renal disease [1]. According to the so-called Maastricht classification, DCD donors are classified into “uncontrolled DCD” for Maastricht categories I (dead on arrival) and II (unsuccessful resuscitation), and “controlled DCD” for Maastricht categories III (awaiting cardiac arrest) and IV (cardiac arrest while brain dead and allocation completed) [2]. In Switzerland, the procurement of organs from DCD donors is only allowed if cardiocirculatory arrest occurs within 60 minutes after therapy withdrawal, followed by brain death diagnosis after 10 minutes of documented circulatory arrest. Artery cannulation for distal perfusion or invasive measures, such as a fast track laparotomy, are not allowed before brain death diagnosis. One should keep in mind however, that DCD is only possible from selected patients. Furthermore, organ procurement from DCD donors is a demanding procedure which is mainly performed in highly specialised centres. Therefore, the number of DCD donors and the impact on the transplant activity remains relatively low.