Premium
Policies towards donation after circulatory death liver transplantation: the need for a guideline?
Author(s) -
Reeven Marjolein,
Pirenne Jacques,
Muiesan Paolo,
Fondevila Constantino,
IJzermans Jan N. M.,
Polak Wojciech G.
Publication year - 2019
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.614
Subject(s) - medicine , donation , guideline , liver transplantation , transplantation , limiting , laparotomy , surgery , intensive care medicine , mechanical engineering , pathology , engineering , economics , economic growth
Background Liver transplantation ( LT ) using grafts from donation after circulatory death ( DCD ) is evolving to standard of care in many countries. Various transplant centers have developed a protocol for DCD ‐ LT . The existence of numerous protocols may cause inconsistencies. Knowledge of these differences may help improve the outcome of DCD ‐ LT . Methods An internet‐based survey was sent to 119 transplant surgeons among four countries: Belgium ( BE ), the Netherlands ( NL ), Spain ( ES ) and the United Kingdom ( UK ). Results Thirty‐three percent of all respondents indicated having no specific age limit for DCD ‐ LT donors, and if there was a limit, half of them ignored it. Calculation of donor warm ischemia time ( dWIT ) varied substantially between countries. In ES and the UK , the starting point of dWIT was defined as deterioration of saturation/blood pressure, while in NL , cardiac arrest was used as starting point. Seventy‐eight percent of the respondents used a super‐rapid sterno‐laparotomy as procurement technique. Surgeons from NL and BE mainly used aortic perfusion (95% and 72%), while dual perfusion was more common in the UK (90%) and ES (91%). Conclusions This study demonstrates major differences in approach to DCD ‐ LT . To assure both donors and recipients a consistent standard of care, a consensus meeting on DCD ‐ LT is highly recommended.