The Multi-Organ Transplant Program, London Health Sciences Centre, the Division of General Surgery, Department of Surgery, University of Western Ontario, London, ON.
Can J Surg. 2010 Apr;53(2):93-102.
The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs.
We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors.
The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) micromol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%.
Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged.
在加拿大，每年等待器官移植的患者数量与可供移植器官的数量之间存在差距。在预后无望的患者停止生命支持后进行心死亡后的捐献（DCD）是解决短缺问题的一种手段，有可能增加可移植器官的数量。
我们对 2006 年 7 月至 2007 年 12 月期间在伦敦健康科学中心多器官移植项目中从 12 位心死亡供体中获取的器官进行了回顾性、单中心图表回顾。总共从 12 位 DCD 供体中获取了 34 个实体器官（24 个肾脏和 10 个肝脏）。
供体的平均年龄为 38 岁（范围 18-59 岁）。死亡原因包括颅脑创伤（n=7）、脑血管意外（n=4）和脑缺氧（n=1）。我们中心移植了所有 10 个肝脏，24 个肾脏中的 14 个；另外 10 个肾脏在其他中心移植。肾脏冷缺血时间平均为 6 小时（范围 3-9.5 小时）。14 例肾移植受者中有 12 例（86%）发生延迟移植物功能，但所有肾脏均恢复功能。1 年随访时，肾功能良好，血清肌酐水平平均为 145μmol/L（范围 107-220μmol/L），估算肌酐清除率平均为 64mL/min（范围 41-96mL/min）。肝脏冷缺血时间平均为 5.8 小时（范围 5.5-8 小时）。有 1 例原发性无功能，需要再次移植。其余 9 个肝脏功能良好。1 例患者发生胆吻合口狭窄，经内镜支架置入后缓解。所有肝移植受者在平均 11 个月（范围 3-20 个月）的随访后均存活。自该 DCD 项目启动以来，转介到我们中心的供体数量增加了 14%。
我们的初步结果与脑死亡供体器官移植的结果相当。心死亡后捐献可以成为增加可移植器官数量的重要手段，应鼓励在加拿大广泛实施。
