Bello Irene, Palleschi Alessandro, Cypel Marcelo, Argudo Eduard, Sandiumenge Alberto
Thoracic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
Donation and Transplantation of Organs, Tissues and Cells, VHIR, Barcelona, Spain.
JHLT Open. 2025 Aug 14;10:100374. doi: 10.1016/j.jhlto.2025.100374. eCollection 2025 Nov.
Uncontrolled donation after circulatory death (uDCD) represents a promising yet underutilized approach to expanding the lung donor pool amid persistent organ shortages. Since the first successful lung transplantation from a uDCD donor in 2001, increasing clinical experience and advancements in organ preservation have demonstrated its feasibility. This review critically explores historical evolution, physiological basis, preservation techniques, ethical and legal considerations, and clinical outcomes of uDCD lung transplantation. The lung's unique ability to maintain viability through passive oxygen diffusion in the absence of perfusion supports its potential in the uDCD context. Compared to donors after brain death (DBD), uDCD donors may avoid systemic inflammatory response, potentially preserving graft quality. However, concerns persist regarding ischemia-reperfusion injury and mitochondrial dysfunction, highlighting the need for mitigation strategies such as ex vivo lung perfusion and normothermic ventilation. Ethical and legal challenges-particularly those related to the determination of death and consent-remain key obstacles. Organizational demands, including rapid coordination between prehospital, hospital teams and transplant teams, further limit broader implementation. Despite these barriers, reported outcomes are encouraging: to date, over 70 transplants from uDCD donors have been documented, with 1-year survival rates ranging from 71% to 87.5% and long-term outcomes comparable to DBD transplants. Integration of uDCD into routine clinical practice will require standardized protocols, robust public engagement, and institutional commitment. When appropriately implemented, uDCD lung transplantation offers a viable opportunity to increase donor availability and improve access to life-saving treatment.
在器官持续短缺的情况下，循环性死亡后器官的非控制性捐献（uDCD）是一种有前景但未得到充分利用的扩大肺供体库的方法。自2001年首次成功进行来自uDCD供体的肺移植以来，不断增加的临床经验和器官保存技术的进步已证明了其可行性。这篇综述批判性地探讨了uDCD肺移植的历史演变、生理基础、保存技术、伦理和法律考量以及临床结果。肺在无灌注情况下通过被动氧扩散维持生存能力的独特能力支持了其在uDCD背景下的潜力。与脑死亡（DBD）后的供体相比，uDCD供体可能避免全身炎症反应，从而有可能保存移植物质量。然而，对缺血再灌注损伤和线粒体功能障碍的担忧依然存在，这凸显了采取如体外肺灌注和常温通气等缓解策略的必要性。伦理和法律挑战，尤其是与死亡判定和同意相关的挑战，仍然是主要障碍。包括院前、医院团队和移植团队之间快速协调在内的组织要求进一步限制了其更广泛的实施。尽管存在这些障碍，但报告的结果令人鼓舞：迄今为止，已记录了超过70例来自uDCD供体的移植手术，1年生存率在71%至87.5%之间，长期结果与DBD移植相当。将uDCD纳入常规临床实践将需要标准化方案、强有力的公众参与和机构承诺。当适当实施时，uDCD肺移植为增加供体可用性和改善获得挽救生命治疗的机会提供了一个可行的机会。
