Singh S, Kumar S, Dasgupta S, Kenwar D B, Rathi M, Sharma A, Kohli H S, Jha V, Gupta K L, Minz M
Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Nephrol. 2017 May-Jun;27(3):205-209. doi: 10.4103/0971-4065.202843.
Donation after circulatory death (DCD) has never been attempted in India because of legal constraints and lack of guidelines for the withdrawal of life support in end-of-life situations. The present report describes the initial experience of transplantation of organs from DCD donors in a tertiary care center in India. Between 2011 and 2015, five donors had kidneys retrieved after cardiac arrest. These patients were declared dead after waiting for 5 min with no electrocardiographic signal on monitor following cardiopulmonary resuscitation (CPR), which was restarted in three patients till organ retrieval. All donors received heparin and underwent rapid cannulation of aorta, infusion of preservative cold solution, and immediate surface cooling of organs during retrieval surgery. 9/10 kidneys were utilized. Mean donor age was 29.6 ± 16.3 years, M:F 4:1 and mean age of recipients was 38.7 ± 10.8 years, M:F 7:2. Seven patients required dialysis in postoperative period. Mean postoperative day 0 urine output was 1.9 ± 2.6 L. Baseline creatinine achieved was 1.38 ± 0.35 mg/dl after a mean duration of 26.12 ± 15.4 days. Kidneys from donors where CPR was continued after the declaration of death ( = 3) had better recovery of renal function (time to reach baseline creatinine 21.2 ± 7.2 vs. 34.3 ± 23.7 days, baseline creatinine 1.36 ± 0.25 vs. 1.52 ± 0.45 mg%). In donors without CPR, one kidney never functioned and others had patchy cortical necrosis on protocol biopsy, which was not seen in the kidneys from donors with CPR. Kidneys from DCD donors can serve as a useful adjunct in deceased donor program. Continuing CPR after the declaration of death seems to help in improving outcomes.
由于法律限制以及在临终情况下缺乏撤除生命支持的指导方针，印度从未尝试过循环死亡后器官捐献（DCD）。本报告描述了印度一家三级护理中心开展DCD供体器官移植的初步经验。2011年至2015年期间，有5名供体在心脏骤停后肾脏被获取。这些患者在心肺复苏（CPR）后监护仪上无心电图信号，等待5分钟后被宣布死亡，其中3名患者在器官获取前再次进行了CPR。所有供体均接受了肝素治疗，并在获取手术期间进行了主动脉快速插管、灌注冷保存液以及对器官立即进行体表降温。10个肾脏中有9个被利用。供体平均年龄为29.6±16.3岁，男性与女性比例为4:1，受体平均年龄为38.7±10.8岁，男性与女性比例为7:2。7名患者术后需要透析。术后第0天平均尿量为1.9±2.6升。平均26.12±15.4天后，基线肌酐达到1.38±0.35毫克/分升。在宣布死亡后继续进行CPR的供体（n = 3）的肾脏，肾功能恢复情况更好（达到基线肌酐的时间为21.2±7.2天，而未继续CPR的为34.3±23.7天；基线肌酐为1.36±0.25毫克/分升，而未继续CPR的为1.52±0.45毫克%）。在未进行CPR的供体中，1个肾脏从未发挥功能，其他肾脏在方案活检时出现散在的皮质坏死，而在进行CPR的供体的肾脏中未见到这种情况。DCD供体的肾脏可作为尸体供体项目中的一种有用补充。宣布死亡后继续进行CPR似乎有助于改善结果。
