Organ donation after controlled circulatory death (Maastricht classification III) following the withdrawal of life-sustaining treatment in Korea: a suggested guideline

Abstract

The "Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life" was enacted in February 2018 in Korea. Therefore, we suggest a Korean guideline for organ donation after circulatory death (DCD) category III after the withdrawal of life-sustaining treatment (WLST). Implementation of WLST includes stopping ventilation, extubation, discontinuation of inotropics and vasoconstrictors, cessation of continuous renal replacement therapy, and cessation of extracorporeal membrane oxygenation. Medical staff involved in organ procurement or transplantation surgery cannot participate in the WLST process. Following cardiac arrest, 5 minutes of "no touch time" should pass, after which circulatory death can be declared. The procurement team can enter the room after the declaration of death. The final procurement decision is made after the surgeon visually checks the organ condition. DCD category III activation in Korea will help increase organ donation and reduce the demand-supply mismatch of organ transplantation.

Keywords: Donation after circulatory death; Guideline; Korea; Organ donation; Withdrawal of life-sustaining treatment.

Fig. 1

The process of controlled donation after circulatory death. SBP, systolic blood pressure; SpO₂, peripheral oxygen saturation; hRP, hypothermic regional perfusion; nRP, normothermic regional perfusion; WLST, withdrawal of life-sustaining treatment.

Fig. 2

Records of the clinical status of donors after circulatory death [16]. KONOS, Korean Network for Organ Sharing; DCD, donation after circulatory death; DNR, do-not-resuscitate order; HR, heart rate; SBP, systolic blood pressure; RR, respiration rate; SpO2, peripheral oxygen saturation.