One OPO's 17 Year Experience with Uncontrolled DCD Donors

Richard D. Hasz¹, Howard M. Nathan¹, John D. Abrams¹, Sharon M. West¹, Michael J. Moritz, MD¹

¹Gift of Life Donor Program, Philadelphia, PA, United States

Aim: To show that uncontrolled DCD organ donation can lead to successful retrieval of tx organs & to evaluate kidney & liver tx outcomes for recipients of organs from uncontrolled donors

Methods: Single OPO, multi-center retrospective study evaluating the procurement and utilization of organs from uncontrolled DCD donors. Graft survival was evaluated using the Kaplan-Meir method.

Results: Between 1996 and 2012, 290 kidneys, 33 livers & 3 pancreata were recovered for tx from 148 uncontrolled DCD donors resulting in the tx of 198 kidneys, 12 livers, and 2 pancreata. Mean donor age was 31 yrs (r = 05-76). Mean warm ischemic time (WIT) of 66 mins (r = 9-214) for the 74 Maastricht Category (MC) II donors was significantly higher than the mean WIT of 45 mins (r = 2-177) for the 74 brain dead donors recovered subsequent to unexpected arrest (MC IV). Kidney utilization rate was 65% for MC II donors and was 72% for MC IV donors and the liver utilization rate was 58% for MC II donors and 24% for MC IV donors. The ATN rate for kidney recipients was not significantly different between the 2 categories (53% ATN rate for MC II & a 56% ATN for MC IV). Kidney graft survival for MC IV was 86% at 6 mos, 80% at 1 yr, 72% at 3 yrs and 61% at 5 yrs. Kidney graft survival for MC II was 80% at 6 mos, 74% at 1 yr, 65% at 3 yrs and 59% at 5 yrs. Of the 7 livers txd from MC II, 6 failed within 60 days of tx and the 7th functioned for 12 years, 7 mos post-tx.  Of the 5 livers txd from MCIV, 3 failed within 65 days of tx and 2 are functioning at 11 yrs and 5 yrs post-tx.

Conclusion: Uncontrolled DCDs provide acceptable kidney graft survival outcomes and represnt a pool of organs that should be pursued for transplantation.  Results from the small number of liver tx are disappointing. 

Figure 1