Seth Avnish K, Mohanka Ravi, Navin Sumana, Gokhale Alla Gk, Sharma Ashish, Kumar Anil, Ramachandran Bala, Balakrishnan K R, Mirza Darius, Mehta Dhvani, Zirpe Kapil G, Dhital Kumud, Sahay Manisha, Simha Srinagesh, Sundaram Radha, Pandit Rahul, Mani Raj K, Gursahani Roop, Gupta Subash, Kute Vivek B, Shroff Sunil
Manipal Organ Sharing and Transplant (MOST), Manipal Hospital, New Delhi, India.
Department of Liver Transplant and HPB Surgery, Reliance Foundation Hospital, Mumbai, Maharashtra, India.
Indian J Crit Care Med. 2022 Summer;26(4):421-438. doi: 10.5005/jp-journals-10071-24198.
Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries. In India, majority of deceased donations happen following brain death (BD). While existing legislation allows for DCDD, there have been only few reports of kidney transplantation following DCDD from India. This document, prepared by a multidisciplinary group of experts, reviews international best practices in DCDD and outlines the path for DCDD in India. Ethical, medical, legal, economic, procedural, and logistic challenges unique to India have been addressed. The practice of withdrawal of life-sustaining treatment (WLST) in India, laid down by the Supreme Court of India, is time-consuming, possible only in patients in a permanent vegetative state, and too cumbersome for day-to-day practice. In patients where continued medical care is futile, the procedure for WLST is described. In controlled DCDD (category-III), decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Families that are inclined toward organ donation are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand-down and return to the intensive care unit (ICU) without donation. In donation following neurologic determination of death (DNDD), if cardiac arrest occurs during the process of BD declaration, the protocol for DCDD category-IV has been described in detail. In DCDD category-V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the ICU. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and techniques, such as normothermic regional perfusion (nRP) and machine perfusion, has been provided. The outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for successful execution of DCDD in India are described.
Seth AK, Mohanka R, Navin S, Gokhale AGK, Sharma A, Kumar A, . Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper. Indian J Crit Care Med 2022;26(4):421-438.
在多个国家，循环判定死亡后器官捐赠（DCDD）对供体库贡献显著。在印度，多数已故者捐赠发生在脑死亡（BD）之后。虽然现有立法允许DCDD，但印度仅有少数关于DCDD后肾移植的报道。本文档由多学科专家小组编写，回顾了DCDD的国际最佳实践，并概述了印度DCDD的发展路径。文中探讨了印度特有的伦理、医学、法律、经济、程序和后勤方面的挑战。印度最高法院规定的维持生命治疗撤除（WLST）实践耗时较长，仅适用于处于永久性植物状态的患者，日常操作过于繁琐。对于继续医疗无效的患者，描述了WLST程序。在可控性DCDD（III类）中，WLST的决定独立于且与后续器官捐赠的可能性脱钩。向倾向于器官捐赠的家庭解释该程序，包括WLST的时间和地点、生前措施的同意、无接触期以及不进行捐赠而撤下并返回重症监护病房（ICU）的可能性。在神经学判定死亡后捐赠（DNDD）中，如果在脑死亡宣告过程中发生心脏骤停，详细描述了IV类DCDD的方案。在V类DCDD中，重症监护病房心脏骤停心肺复苏失败后可能进行器官捐赠。提供了DCDD后肾、肝、心和肺移植的器官特异性要求概述以及常温区域灌注（nRP）和机器灌注等技术。DCDD后的移植结果与脑死亡后捐赠（DBDD）或活体供体移植的结果相当。描述了印度成功实施DCDD所需的文件和清单。
Seth AK, Mohanka R, Navin S, Gokhale AGK, Sharma A, Kumar A, 。《印度循环判定死亡后的器官捐赠：联合立场文件》。《印度重症监护医学杂志》2022；26(4):421 - 438。
