Liver Transplantation From Uncontrolled DCD Donors

Abstract

Uncontrolled donation after circulatory death (uDCD) donors suffer sudden and unanticipated cardiac arrest, typically outside the hospital setting. After advanced cardiopulmonary resuscitation has been attempted and determined to be unsuccessful, uDCD may be considered. At present, all programs recovering and transplanting uDCD livers rely on postmortem normothermic regional perfusion (NRP) to restore the flow of oxygenated blood following declaration of death. In this chapter, we discuss different aspects related to liver transplantation uDCD donors, including logistical and ethical issues surrounding the uDCD process, the use of NRP, graft and recipient selection criteria, perioperative recipient management, and post-transplantation outcomes that have been reported to date. We aim to demonstrate that, while uDCD is complex and the yield of livers for transplantation remains relatively low, it is nonetheless a viable alternative to more standard forms of liver donation and one that may be able to be expanded in the coming years through advances in both donor maintenance and ex situ organ preservation.