Division of Anesthesiology and Algology, University Hospitals Leuven, Leuven, Belgium.
Curr Opin Anaesthesiol. 2013 Jun;26(3):382-90. doi: 10.1097/ACO.0b013e328360dc87.
Donor shortage has forced transplant teams to explore new methods to increase the potential donor pool. Donation after circulatory death (DCD) has opened new perspectives and could be a valuable option to expand the brain-dead donors. The purpose of this review is to provide an overview of current practice and to identify remaining questions related to ethical and medical issues that should be further addressed in the future.
Recent findings demonstrate acceptable outcomes after DCD kidney and lung transplantation but inferior graft survival for liver transplantation. The impact and importance of the agonal phase following withdrawal of treatment in controlled DCD is increasingly recognized. Premortem interventions are currently under debate related to preservation strategies or comfort therapy. New preservation strategies using in-situ/in-vivo extracorporeal membrane oxygenation or ex-vivo machine perfusion have large potential in the future. Finally, organizations and institutions are reporting more uniform guidelines related to declaration of death and DCD organ procurement.
DCD donation has regained much attention during the last decade and is now part of standard clinical practice albeit this type of donation should not be regarded as an equally acceptable alternative for donation after brain death. It will be important to further explore the potential of DCD, to monitor the long-term outcomes and to further optimize the quality of these grafts. Development and implementation of uniform guidelines will be necessary to guarantee the clinical use of these donor pools.
供体短缺迫使移植团队探索新方法来增加潜在供体库。心跳停止后捐献（DCD）开辟了新的视角，可能是扩大脑死亡供体的有价值选择。本文的目的是提供当前实践的概述，并确定与伦理和医学问题相关的遗留问题，这些问题应在未来进一步解决。
最近的研究结果表明，DCD 肾和肺移植后可获得可接受的结果，但肝移植的移植物存活率较低。在控制性 DCD 中，治疗停止后的濒死期的影响和重要性越来越受到重视。目前正在讨论关于保存策略或舒适治疗的生前干预措施。使用原位/体外线粒体膜氧合或离体机器灌注的新保存策略在未来具有很大的潜力。最后，各组织和机构报告了与死亡宣告和 DCD 器官获取相关的更统一的指南。
在过去十年中，DCD 捐献重新引起了人们的关注，现在已成为标准临床实践的一部分，尽管这种类型的捐献不应被视为与脑死亡后捐献同样可接受的替代方案。进一步探索 DCD 的潜力、监测长期结果并进一步优化这些移植物的质量非常重要。制定和实施统一的指南对于保证这些供体库的临床应用是必要的。
