Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
World J Gastrointest Surg. 2011 Nov 27;3(11):167-76. doi: 10.4240/wjgs.v3.i11.167.

Current status and recent advances of liver transplantation from donation after cardiac death.

Author information

  • 1M Thamara PR Perera, Simon R Bramhall, The Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.

Abstract

The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a significant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably "prematurely" offered without ideal donor management or even prior to brain death being established. The absolute benefits of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.

KEYWORDS:

Liver graft; Modulation; Non-heart beating donor; Primary non-function; Reperfusion injury

PMID:
22180833
[PubMed]
PMCID:
PMC3240676
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Baishideng Publishing Group Inc. Icon for PubMed Central
    Loading ...
    Write to the Help Desk