PMC:6537946 / 28785-30740 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6537946","sourcedb":"PMC","sourceid":"6537946","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6537946","text":"Current developments in transplants: donation after circulatory death\nSince the first human heart transplant [42], declaring death prior to organ procurement had historically been based on the cessation of circulation. However, following the subsequent increase in the discussions about death criteria, later heart transplants were not carried out until the death of the donor’s brain had been verified using a previously accepted definition of brain death [62]. The current shortage of organs forced the revitalization of the method of donation after circulatory death (DCD) because some dying patients will never meet formal brain death criteria. The Maastricht agreement defined 5 categories based on the circumstances of the cardiac arrest, of which only selected cohorts can lead to DCD donations [63]. Once cardiac function has ceased and death has been declared, the heart must be retrieved as soon as possible. Unlike procurement after brain death, there is perforce a period of cardiac ischaemia and ventricular distention that can compromise the vitality of the organ after removal and that was the source of initial concern regarding the vitality of DCD hearts after retrieval [64]. Ex vivo perfusion and/or normothermic regional perfusion may guarantee graft metabolism and function and ensure post-transplant function [65, 66]. Early outcome of a DCD heart transplant is apparently comparable with outcomes with a transplant from a donation after brain death [67], and thus DCD programmes have contributed to greater transplant activity in some regions [68, 69]. Whether the DCD programme can be successfully implemented worldwide remains to be seen: although some countries successfully perform transplants in compliance with the DCD, the German Medical Association declared in 1998 that organ procurement and transplants in Germany may not follow the DCD criteria because they do not fulfil the strict German ethical end-of-life 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