Abstract
IntroductionA chronic shortage of organs remains the main factor limiting organ transplantation. Many countries have explored the option of uncontrolled donation after circulatory death (uDCD) in order to expand the donor pool. Little is known regarding the variability of practices and outcomes between existing protocols. This systematic review addresses this knowledge gap informing policy makers, researchers, and clinicians for future protocol implementation.MethodsWe searched MEDLINE, EMBASE, and Google Scholar electronic databases from 2005 to March 2015 as well as the reference lists of selected studies, abstracts, unpublished reports, personal libraries, professional organization reports, and government agency statements on uDCD. We contacted leading authors and organizations to request their protocols and guidelines. Two reviewers extracted main variables. In studies reporting transplant outcomes, we added type, quantity, quality of organs procured, and complications reported. Internal validity and the quality of the studies reporting outcomes were assessed, as were the methodological rigour and transparency in which a guideline was developed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015258).ResultsSix guidelines and 18 outcome studies were analysed. The six guidelines are based on limited evidence and major differences exist between them at each step of the uDCD process. The outcome studies report good results for kidney, liver, and lung transplantation with high discard rates for livers.ConclusionsDespite procedural, medical, economic, legal, and ethical challenges, the uDCD strategy is a viable option for increasing the organ donation pool. Variations in practice and heterogeneity of outcomes preclude a meta-analysis and prevented the linking of outcomes to specific uDCD protocols. Further standardization of protocols and outcomes is required, as is further research into the role of extracorporeal resuscitation and other novel therapies for treatment of some refractory cardiac arrest. It is essential to ensure the maintenance of trust in uDCD programs by health professionals and the public.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0985-7) contains supplementary material, which is available to authorized users.
Highlights
A chronic shortage of organs remains the main factor limiting organ transplantation
Despite procedural, medical, economic, legal, and ethical challenges, the uncontrolled donation after circulatory death (uDCD) strategy is a viable option for increasing the organ donation pool
It is essential to ensure the maintenance of trust in uDCD programs by health professionals and the public
Summary
A chronic shortage of organs remains the main factor limiting organ transplantation. Many countries have explored the option of uncontrolled donation after circulatory death (uDCD) in order to expand the donor pool. A chronic shortage of organs remains the main factor limiting organ transplantation for patients with end-stage organ failure. In Europe, nearly 99,000 patients were waiting for an organ in 2013 whilst the number of deceased donors has remained stable at approximately 9900 [1]. This is the case in the US, where 30,000 patients were on waiting lists and the number of deceased donors was 8268 [1]. The mismatch between supply and demand for organs has led policy makers and health institutions to develop new strategies aimed at expanding the organ donor pool. Many countries worldwide have explored the option of donation after circulatory death (DCD)
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