ORIGINAL ARTICLE   Free

Minerva Anestesiologica 2018 December;84(12):1387-92

DOI: 10.23736/S0375-9393.18.12635-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Implementing a donation after circulatory death program in a setting of donation after brain death activity

Adriano PERIS ^{1, 2} ✉, Chiara LAZZERI ¹, Giovanni CIANCHI ¹, Manuela BONIZZOLI ¹, Stefano BATACCHI ¹, Andrea FRANCI ¹, Mario RUGNA ³, Lucia DE VITO ³, Pier F. TICALI ⁴, Vincenzo LI MARZI ⁵, Maria L. MIGLIACCIO ¹

¹ Unit of Intensive Care and Regional ECMO Referral Center, Emergency Department, Careggi University Hospital, Florence, Italy; ² Tuscany Authority for Transplantation (Centro Regionale Allocazione Organi e Tessuti CRAOT), Florence, Italy; ³ Emergency Medical System, Florence, Italy; ⁴ Department of Emergency Medicine, Careggi University Hospital, Florence, Italy; ⁵ Department of Urology, Careggi University Hospital, Florence, Italy

BACKGROUND: Donation after circulatory death (DCD) is an emerging way to implement organ procurement for transplantation. In Italy, until June 2016, the only formal DCD program was implemented in Pavia, the so-called “Alba program.”
METHODS: We describe our one-year experience of the DCD program implemented at the Careggi Teaching Hospital (Florence, Italy) since June 2016. We specifically describe organizational changes induced by the DCD program on our pre-existing Donation After Brain Death (DBD) program and DCD activity.
RESULTS: Eighteen activations were recorded (i.e. 18 DCD donors), among whom Seven donors were discarded due to opposition in five patients and failure to meet activation criteria in two (inability to contact relatives). Our population comprises 11 donors among whom eight patients were Maastricht type II donors while three were Maastricht type III donors. 22 kidneys and six livers were retrieved, while 13 kidneys and two liver were transplanted.
CONCLUSIONS: A DCD program was feasible and increased procurement of splancnic organs (kidney and liver). Starting a DCD program in a traditionally oriented to DBD poses some organizational and cultural problems. A skilled, experienced ECMO team is necessary to guarantee organ ex vivo perfusion. Another important aspect for the implementation of a DCD program is the collaboration with the emergency system which allows a therapeutic approach of patients with cardiac arrest.

KEY WORDS: Directed tissue donation - Extracorporeal membrane oxygenation - Tissue and organ procurement