Donation after cardiac death - From then to now

At the early days of organ transplantation before the diagnosis of brain death came in use only organs of non-heart-beating persons - who were the first donors after cardiac death (DCD) - could be taken for organ transplantation beside the living donors.

Organs from the first brain-dead donor were transplanted in 1963 in Belgium, five years later the famous Harvard Committee criteria were published. Following that in the Western world DCD was not used for organ transplantation, just in exceptional cases for several decades.

However, organ scarceness lead the way back to the idea of DCD. The original Maastricht classification discerns uncontrolled and controlled DCD in 4 categories from dead upon arrival through unsuccessful resuscitation attempt and awaiting cardiac death to cardiac arrest of a brain-dead person.

The time between the cessation of the of the circulation and the perfusion of the organ with the specific storage fluid is crucial for the possible use of the organs as transplants.

The recent studies explore the possibilities of the reconditioning of the organs to allow more and more of them to use for transplantation. The applicability is mostly needed in DCD cases. It is still open whether cold or warm perfusion, static or machine perfusion in continuous or pulsatile form would be the best for which organ.

Despite the evidence of the usefulness of this donor category, DCD is still not used universally. For example in Europe only one-third of the countries use DCD, the main reason is the underdevelopment of the infrastructural criteria in some of the countries, and the unsolved ethical and organizational challenges in others.