• Donation after circulatory death (DCD)
    • Considered if no hope of recovery and withdrawal of treatment is considered
    • Warm ischaemia commences when there is inadequate oxygenation or perfusion (SAP <50mmHg, O₂ sats <70%)
    • Cold ischaemia occurs following cold preservation until restoration of warm circulation after transplant
    • DCD selection
      • Controlled
        • Planned donation before death
      • Uncontrolled
        • Died prior to consideration
      • Contraindications
        • Invasive carcinoma within last 3 yrs
        • Haematological malignancy
        • Untreated systemic infection
        • vCJD
        • HIV disease (but not necessarily HIV infection)
      • Suitable organs
        • Kidneys
        • Liver
        • Pancreas
        • Lungs
        • Tissue (valves, cornea, bone, skin)
    • Withdrawal & confirmation of death
      • Withdrawal when retrieval team present in theatre
      • Death confirmed by doctor
      • 5 min observation
      • Absence of circulation confirmed by art line or ECG (not central pulse)
      • Retreival can occur after 10 mins of circulatory arrest (usually relative attendance time)
      • Lungs may need reintubating after death confirmed if extubated but do not reinstitute ventilation until after exclusion of cerebral circulation
    • Practical approach
      • Inform transplant co-ordinator of intention to withdraw treatment
      • Transplant co-ordinator to establish social, medical or behavioural risk factors
      • Family can specify organs
      • Research specimens only with consent
      • Realistic timescale indicated
      • Limited time with deceased
      • Organ donation may not be possible
      • Can stop donation at any stage
    • Organ specific recommendations
      • Renal
        • Warm ischaemia < 2hrs
        • No history of CRF
        • Can be extended at discression of retrieval surgeon
      • Liver
        • Warm ischaemia < 30 mins
        • No history of cirrhosis/Portal vein thrombosis
      • Pancreas
        • Warm ischaemia < 30 mins
        • No history of diabetes
        • BMI <35, age <65
      • Lung
        • Warm ischaemia < 1hr
        • CI - COPD, empyema, asthma requiring steroids, >65 yrs old
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/11/3/82.full.pdf