Abstract
BackgroundOrgan donation after brain death (DBD) is the standard strategy for organ transplantation; however, the concept of brain death is not universally accepted due to cultural beliefs and barriers amongst billions of people worldwide. Hence, a novel donation pattern has been established in China which outlines the concept of donation after brain death followed by circulatory death (DBCD). Differently from any current donation classification, this new concept is formulated based on combination of recognizing brain death and circulatory death. Should approval be gained for this definition and approach, DBCD will pave a novel donation option for billions of people who cannot accept DBD due to their cultural beliefs.MethodsA multi-center, cohort study was conducted from February 2012 to December 2015. 523 kidney transplant recipients from four kidney transplant institutions were enrolled into the study, of which, 383 received kidneys from DBCD, and 140 from DBD. Graft and recipient survivals following transplantation were retrospectively analyzed. Postoperative complications including delayed graft function,, and acute rejection, were also analyzed for both groups.ResultsDBCD could achieve comparable graft and recipient survivals in comparison with DBD (Log-rank P = 0.32 and 0.86,respectively). One-year graft and recipient survivals were equal between DBCD and DBD groups (97.4% versus 97.9%, P = 0.10;98.4% versus 98.6%, P = 1.0, respectively). Furthermore, DBCD did not increase incidences of postoperative complications compared with DBD, including delayed graft function (19.3% versus 22.1%, P = 0.46) and acute rejection (9.1% versus 8.6%, P = 1.0). Additionally, antithymocyte globulin as induction therapy and shorter warm ischemia time decreased incidence of delayed graft function in DBCD group (16.8% on antithymocyte globulin versus 27.2% on basiliximab, P = 0.03; 16.7% on ≤18 min versus 26.7% on > 18 min group, P = 0.03).ConclusionsKidney donation through DBCD achieves equally successful outcomes as DBD, and could provide a feasible path to graft availability for billions of people who face barriers to organ donation from DBD.
Highlights
Organ donation after brain death (DBD) is the standard strategy for organ transplantation; the concept of brain death is not universally accepted due to cultural beliefs and barriers amongst billions of people worldwide
A novel donation concept namely organ donation after brain death followed by circulatory death (DBCD) was officially initiated in 2011, which could be regarded as combination of recognizing brain death and circulatory death [11, 12]
These donors should first be declared as brain dead, and processed with planned withdrawal of mechanical support, and subsequent execution of cardiac death protocols, which is totally different from the international common practice of Maastricht criteria of donation after cardiac death [11, 12]
Summary
Organ donation after brain death (DBD) is the standard strategy for organ transplantation; the concept of brain death is not universally accepted due to cultural beliefs and barriers amongst billions of people worldwide. Kidney donation after brain death (DBD) is considered the standard donation strategy and has been established in Western countries, there are many obstacles preventing acceptance of the Harvard criteria for brain death in some countries, such as China and Japan [2,3,4,5,6]. Should approval be gained for this definition and approach, DBCD will pave a novel donation option for billions of people who cannot accept DBD due to their cultural beliefs To this end, we conducted a multi-center cohort study to compare outcomes from kidney donation through DBCD compared with DBD
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