UNCONTROLLED DONATION AFTER CIRCULATORY DEATH: A BY-PRODUCT OF THE CONTROLLED? A NARRATIVE REVIEW

Abstract

Uncontrolled DCD (uDCD) refers to donation from persons who die because of an unexpected and sudden cardiac arrest after unsuccessful resuscitation. This type of donation pathway has important organizational issues since it can be considered part of the out of hospital cardiac arrest resuscitation bundle. Two are the main challenges of an uDCD program. The first is represented by legal, ethical and, mostly, organizational issues. Secondly, on a pathophysiologic view and strictly concerning to organ transplantation, the ischemia/reperfusion injury is the main factor able to affect organ function in the uDCD donor. In vivo and ex-vivo perfusion represent, to date, the chief treatment believed to counteract the deleterious effects of ischemia-reperfusion injury in the uDCD donor (normothermic regional perfusion -NRP- for abdominal organs) and in the single organ (ex-vivo machine perfusion), as well as to permit the assessment organ viability during perfusion. Peculiarities of the uDCD pathway in respect to cDCD will be also summarized.