Review
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Nov 27, 2011; 3(11): 167-176
Published online Nov 27, 2011. doi: 10.4240/wjgs.v3.i11.167
Current status and recent advances of liver transplantation from donation after cardiac death
M Thamara PR Perera, Simon R Bramhall
M Thamara PR Perera, Simon R Bramhall, The Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom
Author contributions: Perera MTPR designed the the study, collected, analyzed and made the interpretation of the data, and drafted the article; Bramhall SR designed the conception, revised the manuscript critically for important intellectual content, and made the final approval of the version to be published.
Correspondence to: Mr. Simon R Bramhall, Consultant HPB and Transplant Surgeon, The Liver Unit, Queen Elizabeth Hospital, Nuffield House 3rd Floor, Edgbaston, Birmingham B15 2TH, United Kingdom. simon.bramhall@uhb.nhs.uk
Telephone: +44-121-6272346 Fax: +44-121-4141833
Received: July 30, 2011
Revised: October 21, 2011
Accepted: October 28, 2011
Published online: November 27, 2011
Abstract

The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a significant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably “prematurely” offered without ideal donor management or even prior to brain death being established. The absolute benefits of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.

Keywords: Non-heart beating donor; Liver graft; Primary non-function; Reperfusion injury; Modulation