Vidgren Mathias, Delorme Capucine, Oniscu Gabriel C
Division of Transplantation Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Department of Transplantation Surgery, Karolinska Universitetssjukhuset Huddinge, Huddinge, Sweden.
J Intern Med. 2025 Feb;297(2):124-140. doi: 10.1111/joim.20051. Epub 2025 Jan 20.
In recent years, there has been resurgence in donation after circulatory death (DCD). Despite that, the number of organs transplanted from these donors remains low due to concerns about their function and a lack of an objective assessment at the time of donation. This overview examines the current DCD practices and the classification modifications to accommodate regional perspectives. Several risk factors underscore the reluctance to accept DCD organs, and we discuss the modern strategies to mitigate them. The advent of machine perfusion technology has revolutionized the field of DCD transplantation, leading to improved outcomes and better organ usage. With many strategies at our disposal, there is an urgent need for comparative trials to determine the optimal use of perfusion technologies for each donated organ type. Additional progress in defining therapeutic strategies to repair the damage sustained during the dying process should further improve DCD organ utilization and outcomes. However, there remains wide variability in access to DCD donation and transplantation, and organizational efforts should be doubled up with consensus on key ethical issues that still surround DCD donation in the era of machine perfusion.
近年来，循环性死亡后器官捐献（DCD）出现了复苏。尽管如此，由于担心这些供体器官的功能以及在捐献时缺乏客观评估，从这些供体移植的器官数量仍然很低。本综述探讨了当前的DCD实践以及为适应地区观点而进行的分类修改。有几个风险因素凸显了人们不愿接受DCD器官的情况，我们讨论了减轻这些风险的现代策略。机器灌注技术的出现彻底改变了DCD移植领域，带来了更好的结果和更高的器官利用率。有了多种策略可供使用，迫切需要进行比较试验，以确定针对每种捐赠器官类型的灌注技术的最佳使用方法。在确定修复临终过程中所受损伤的治疗策略方面取得的更多进展，应能进一步提高DCD器官的利用率和移植效果。然而，DCD捐献和移植的可及性仍然存在很大差异，在机器灌注时代，围绕DCD捐献的关键伦理问题上达成共识的组织工作应加倍努力。
