Donation After Circulatory Death
Donation after circulatory death (DCD), previously referred to as donation after cardiac death or non-heartbeating
organ donation, refers to the retrieval of organs for the purpose of transplantation from patients whose death is
diagnosed and confirmed using cardio-respiratory criteria.
There are two principal types of DCD, controlled and uncontrolled. Uncontrolled DCD refers to organ retrieval after a cardiac arrest that is unexpected and from which the patient cannot or should not be resuscitated. In contrast, controlled DCD takes place after death which follows the planned withdrawal of life-sustaining treatments that have been considered to be of no overall benefit to a critically ill patient on ICU or in the Emergency Department. The clinical circumstances in which DCD can occur are described by the Maastricht classification
The Maastricht classification of Donation after Circulatory Death
|1||Uncontrolled||Dead on arrival||Emergency Department|
|2||Uncontrolled||Unsuccessful resuscitation||Emergency Department|
|3||Controlled||Cardiac arrest follows planned withdrawal of life sustaining treatments||Intensive Care Unit|
|4||Either||Cardiac arrest in a patient who is brain dead||Intensive Care Unit|
World-wide, there is considerable variation in the contributions that DCD makes to deceased donation overall. While some countries have no DCD programmes whatsoever, in others such as the UK, Netherlands and Australia the contributions are significant. Furthermore, whilst some countries focus principally on controlled DCD (e.g UK, Australia) or uncontrolled DCD (e.g. France, Spain), other countries such as the Netherlands support both forms of DCD.
Figure 1. Relative contributions of donation after brain death (DBD) and donation after circulatory death (DCD) to deceased donation in various countries around the world, as measured by donors per million population (pmp) in 2013. Data courtesy of Transplant Procurement Management at www.tpm.org.
The relatively high potential for controlled DCD in the UK is likely to be a reflection of the number of deaths in intensive care that follow a decision to limit or withdraw life-sustaining treatments that are considered to be of no overall benefit to a critically ill patient