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. 2021 Mar;47(3):265-281.
doi: 10.1007/s00134-020-06341-7. Epub 2021 Feb 26.

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

Beatriz Domínguez-Gil  1 , Nancy Ascher  2 , Alexander M Capron  3 , Dale Gardiner  4 , Alexander R Manara  5 , James L Bernat  6 , Eduardo Miñambres  7 , Jeffrey M Singh  8 , Robert J Porte  9 , James F Markmann  10 , Kumud Dhital  11 , Didier Ledoux  12 , Constantino Fondevila  13 , Sarah Hosgood  14 , Dirk Van Raemdonck  15 , Shaf Keshavjee  16 , James Dubois  17 , Andrew McGee  18 , Galen V Henderson  19 , Alexandra K Glazier  20 , Stefan G Tullius  21 , Sam D Shemie  22 , Francis L Delmonico  23   24
Affiliations

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative

Beatriz Domínguez-Gil et al. Intensive Care Med. 2021 Mar.

Erratum in

Abstract

A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.

Keywords: Determination of death; Donation after the circulatory determination of death; Normothermic regional perfusion; Organ perfusion; Organ repair; Organ transplantation; Tissue and organ procurement; Withdrawal of life-sustaining therapy.

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Conflict of interest statement

SK is a co-founder of Perfusix Canada (PXCA). This company provides ex situ lung perfusion (EVLP) services and training to University Health Network. Due to conflict of interest relative to EVLP activities as lung transplant surgeons in the institution, SK does not receive any payments from PXCA. Furthermore, with respect to the provision of EVLP services, PXCA is a non-profit company that does not generate profit from EVLP activities provided for UHN patients. SK is a co- founders of XOR Labs Toronto (XOR), a company dedicated to development of EVLP machines. The XOR EVLP machine is in development phase and has not been used in any patients reported on in this manuscript. Lung Bioengineering (LBI), a subsidiary of United Therapeutics, acquired Perfusix USA in 2015, a company that was co-founded by SK. Currently SK is a paid consultant for LBI. He provides strategic advice to LBI lung perfusion center as a member of its Scientific Advisory Board. DVR was a principal investigator in the Inspire and Expand trial sponsored by Transmedics, Inc (Andover, MA, USA). He received travel reimbursement to attend scientific advisory board meetings organized by Transmedics. The rest of the authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Algorithm showing the pathways to death and to organ transplantation. ECMO extracorporeal membrane oxygenation, ICU intensive care unit, VAD ventricular assist device
Fig. 2
Fig. 2
Death determined by the permanent cessation of brain function. The x axis in time is not linear. The time that elapses from 5 min when death is declared by the permanent absence of circulation to an assured irreversibility of brain functions is in hours. DCDD donation after the circulatory determination of death, WLST withdrawal of life-sustaining therapy
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