{"title":"循环性死亡后的捐赠:国际视角","authors":"Barry D. Kahan","doi":"10.1016/j.tpr.2023.100137","DOIUrl":null,"url":null,"abstract":"<div><p>The blossoming transplantation enterprise has increased the demand for human organs beyond those available from living donors. While individuals undergoing donation after brain death (DBD) continue to yield the vast majority of cadaveric organs recovered worldwide, a growing practice recruits donors among patients displaying severe brain injury but not meeting the criterion of electrosilence. These patients include a cohort who cannot maintain their circulation after withdrawal of machine-assisted ventilation and whose families consent to organ retrieval – subjects for donation after cardiocirculatory death (DCD). Expositions in this collection of articles in <em><u>Transplantation</u> <u>Reports</u></em> reveal variable practices worldwide, not only in surgical procedures to recover DCD organs, but also to overcome the ischemia-reperfusion injuries (IRi) consequent to retrieval. The contributions reveal center, national and international guidelines for, as well as outcomes of kidney, liver, lung, cardiac and pancreas transplantations of DCD organs in The United States, South America, Europe, Asia and The Middle East.</p><p>On the one hand, there is little concern about the use of <em><u>ex vivo</u></em> machine perfusion to diagnose, mitigate and treat IRI in DCD organs. On the other hand, <em><u>in vivo</u></em> donor re-vitilization by cardiopulmonary bypass after declaration of death has incited considerable controversy even among medical professionals. Bioethical and biophilosophical considerations as well as public opinion and social consensus must inform forthcoming deliberations of The United States Uniform Determination of Death Act (UDDA) Commission in order to place DCD procedures on a firm footing to meet burgeoning patient needs.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"8 4","pages":"Article 100137"},"PeriodicalIF":0.0000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2451959623000124/pdfft?md5=892d43c881a713c94741929928ad2e41&pid=1-s2.0-S2451959623000124-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Donation after circulatory death: An international view\",\"authors\":\"Barry D. Kahan\",\"doi\":\"10.1016/j.tpr.2023.100137\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>The blossoming transplantation enterprise has increased the demand for human organs beyond those available from living donors. While individuals undergoing donation after brain death (DBD) continue to yield the vast majority of cadaveric organs recovered worldwide, a growing practice recruits donors among patients displaying severe brain injury but not meeting the criterion of electrosilence. These patients include a cohort who cannot maintain their circulation after withdrawal of machine-assisted ventilation and whose families consent to organ retrieval – subjects for donation after cardiocirculatory death (DCD). Expositions in this collection of articles in <em><u>Transplantation</u> <u>Reports</u></em> reveal variable practices worldwide, not only in surgical procedures to recover DCD organs, but also to overcome the ischemia-reperfusion injuries (IRi) consequent to retrieval. The contributions reveal center, national and international guidelines for, as well as outcomes of kidney, liver, lung, cardiac and pancreas transplantations of DCD organs in The United States, South America, Europe, Asia and The Middle East.</p><p>On the one hand, there is little concern about the use of <em><u>ex vivo</u></em> machine perfusion to diagnose, mitigate and treat IRI in DCD organs. On the other hand, <em><u>in vivo</u></em> donor re-vitilization by cardiopulmonary bypass after declaration of death has incited considerable controversy even among medical professionals. Bioethical and biophilosophical considerations as well as public opinion and social consensus must inform forthcoming deliberations of The United States Uniform Determination of Death Act (UDDA) Commission in order to place DCD procedures on a firm footing to meet burgeoning patient needs.</p></div>\",\"PeriodicalId\":37786,\"journal\":{\"name\":\"Transplantation Reports\",\"volume\":\"8 4\",\"pages\":\"Article 100137\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2451959623000124/pdfft?md5=892d43c881a713c94741929928ad2e41&pid=1-s2.0-S2451959623000124-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplantation Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2451959623000124\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2451959623000124","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Donation after circulatory death: An international view
The blossoming transplantation enterprise has increased the demand for human organs beyond those available from living donors. While individuals undergoing donation after brain death (DBD) continue to yield the vast majority of cadaveric organs recovered worldwide, a growing practice recruits donors among patients displaying severe brain injury but not meeting the criterion of electrosilence. These patients include a cohort who cannot maintain their circulation after withdrawal of machine-assisted ventilation and whose families consent to organ retrieval – subjects for donation after cardiocirculatory death (DCD). Expositions in this collection of articles in TransplantationReports reveal variable practices worldwide, not only in surgical procedures to recover DCD organs, but also to overcome the ischemia-reperfusion injuries (IRi) consequent to retrieval. The contributions reveal center, national and international guidelines for, as well as outcomes of kidney, liver, lung, cardiac and pancreas transplantations of DCD organs in The United States, South America, Europe, Asia and The Middle East.
On the one hand, there is little concern about the use of ex vivo machine perfusion to diagnose, mitigate and treat IRI in DCD organs. On the other hand, in vivo donor re-vitilization by cardiopulmonary bypass after declaration of death has incited considerable controversy even among medical professionals. Bioethical and biophilosophical considerations as well as public opinion and social consensus must inform forthcoming deliberations of The United States Uniform Determination of Death Act (UDDA) Commission in order to place DCD procedures on a firm footing to meet burgeoning patient needs.
期刊介绍:
To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI