Donatore a cuore non battente
Donazione di Organi a Cuore fermo
Donor after Cardiac Death - DCD
Non heart beating (NHB) donor
Chi sono i donatori a cuore non battente ?
I donatori d’organo a cuore non battente (in lingua inglese “Non heart beating donors“) sono particolari donatori nei quali il prelievo degli organi viene eseguito dopo che il cuore si é fermato.
I pionieri nel prelievo di organi da donatori a cuore non battente sono stati i chirurgi olandesi (Kootstra G. Statement on non-heart-beating donor programs. Transplant Proc 1995;27:2965). La prima conferenza su questo tipo di donatori é stata tenuta a Maastricht e da questa città prendono il nome le categorie di donazioni a cuore non battente. Da allora vari Paesi hanno emanato una regolamentazione specifica per l’utilizzo di questo tipo di donatori, anche se queste leggi non sono omogenee fra le varie Nazioni e non tutti i Paesi, anche nella stessa Europa, consentono ancora oggi di poterla applicare. Dove è consentito l’utilizzo di donatori a cuore non battente, si é riusciti ad aumentare del 10-15% il numero di organi disponibili per il trapianto, con punte del 20% raggiunte in Olanda.
I termini “controllato” e “non controllato”, che si riferiscono al tempo di ischemia subito dagli organi, non erano stati utilizzati nei documenti iniziali, ma aggiunti in seguito. Il significato di questa espressione è l’identificazione dei donatori (e quindi degli organi) esposti a minima ischemia (controllata) o a ischemia più lunga (non controllata).
Come si individuano i donatori a cuore non battente?
Categoria
Maastricht 1
Stato
Deceduto all’arrivo
Condizione
Non controllati
Frequenza
Rari
Sono pazienti che vengono dichiarati deceduti in ospedale (Categoria 1A) al di fuori dell’ospedale (Categoria 1B) e sono comunque trasportati al Pronto Soccorso.
Non viene eseguito alcun tentativo di rianimazione, perché già deceduti. La causa del decesso può essere un importante trauma cranico o una frattura cervicale.
In questi possibili donatori é possibile prelevare solo i reni, sempre che sia possibile ottenere informazioni precise sul preciso momento del decesso.
La possibilità di ottenere il consenso per la donazione dai parenti o dall’autorità giudiziale può causare ritardi e rendere la donazione degli organi impossibile.
Categoria
Maastricht 2
Stato
Rianimazione inefficace
Condizione
Non controllati
Frequenza
Frequenti
Si tratta di pazienti che vengono rianimati dentro (Categoria 2A) o fuori (Categoria 2B ) dall’ospedale. La causa dell’arresto cardiaco può essere un infarto, una emorragia massiva o un trauma cerebrale.
A causa dell’inefficacia delle manovre rianimatorie, l’equipe medica interrompe i trattamenti e il paziente viene dichiarato deceduto.
Durante il tempo che trascorre fra il decesso e l’espressione di un consenso da parte dei parenti si può continuare ad applicare un massaggio cardiaco esterno e l’applicazione di una ventilazione artificiale per mantenere una certa perfusione negli organi. Una volta ottenuto un consenso al prelievo, gli organi vengono raffreddati immediatamente. Anche in questi casi vengono prelevati solo i reni.
Categoria
Maastricht 3
Stato
Arresto cardiaco imminente
Condizione
Controllati
Frequenza
Meno frequenti
In questo gruppo rientrano diverse situazioni di ammalati che stanno per morire a causa di un danneggiamento cerebrale irreversibile ma che non rientrano nei criteri della morte cerebrale. Il paziente può avere una funzione respiratoria autonoma residua o può essere dipendente dalla ventilazione meccanica.
In ogni caso, gli organi vengono prelevati dopo l’arresto cardiaco, che può avvenire dopo la sospensione della ventilazione assistita.
In questo caso, gli organi sono prelevati in una situazione clinica e logistica perfettamente controllata, come si può ottenere all’interno di una sala operatoria. Dopo l’arresto del cuore, gli organi vengono raffreddati perfondendo l’aorta. E’ possibile il prelievo non dei soli reni, ma anche del fegato, del pancreas e dei polmoni, che vengono trapiantati immediatamente.
Categoria
Maastricht 4
Stato
Arresto cardiaco in morte cerebrale
Condizione
Controllati
Frequenza
Rari
Sono pazienti nei quali insorge un arresto cardiaco durante il periodo di osservazione per la dichiarazione di morte cerebrale o quando sia già stata dichiarata la morte cerebrale (Categortia 4A) ma non siano ancora iniziate le manovre per il prelievo degli organi.
Viene effettuato il raffreddamento degli organi interni per poter procedere il più velocemente possibile al prelievo dei soli reni.
Come vengono regolamentate le procedure per il prelievo degli organi da donatori a cuore non battente?
Il Centro Nazionale Trapianti (CNT) ha pubblicato nell’agosto del 2015 le raccomandazioni operative per la Donazione di Organi a cuore fermo (DCD) in Italia.
- Ultimo aggiornamento della pagina: 08/02/2023
Documenti sulla Donazione d'Organi a Cuore non battente
2022
Botea F; Roumenov G V; Zamfir R; Brasoveanu V; Popescu I
Liver Graft Retrieval in Deceased Donors Book Chapter
In: Makuuchi, Masatoshi; Kokudo, Norihiro; Popescu, Irinel; Belghiti, Jacques; Han, Ho-Seong; Takaori, Kyoichi; Duda, Dan G. (Ed.): The IASGO Textbook of Multi-Disciplinary Management of Hepato-Pancreato-Biliary Diseases, pp. 473–486, Springer Nature Singapore, Singapore, 2022, ISBN: 978-981-19-0063-1.
@inbook{Botea2022,
title = {Liver Graft Retrieval in Deceased Donors},
author = {Florin Botea and Genadyi Vatachki Roumenov and Radu Zamfir and Vladislav Brasoveanu and Irinel Popescu},
editor = {Masatoshi Makuuchi and Norihiro Kokudo and Irinel Popescu and Jacques Belghiti and Ho-Seong Han and Kyoichi Takaori and Dan G. Duda},
url = {https://doi.org/10.1007/978-981-19-0063-1_63},
doi = {10.1007/978-981-19-0063-1_63},
isbn = {978-981-19-0063-1},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
booktitle = {The IASGO Textbook of Multi-Disciplinary Management of Hepato-Pancreato-Biliary Diseases},
pages = {473--486},
publisher = {Springer Nature Singapore},
address = {Singapore},
abstract = {Liver transplantation (LT) is the current curative treatment for end-stage liver disease and has become widespread due to advances in immune-suppression, standardized surgical techniques and strategies to expand the donor pool. However, assuring proper graft quality remains the primary goal in organ retrieval. This goal is achieved by proper organ perfusion to reduce reperfusion injury, and surgical regulations to minimize inadvertent graft injuries. Growing waiting lists have determined the transplant centers to expand the donor pool and reconsider the criteria for acceptable grafts. This has resulted in growing number LTs using extended criteria donors (ECD), living donors (LD), and, more recently and in few countries, donors after circulatory death (DCD). The donor pool was further extended by changing the national policies for donation to opt-out. However, donation after brain death (DBD) remains by far the primary source of organs for transplant. The key points of a successful retrieval are optimal retrieval technique, thorough flushing of the graft, and minimal warm and cold ischemia time.},
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pubstate = {published},
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Lerut J; Lai Q
Deceased Donor Liver Transplantation: The Pendulum of Visions and Ideas Book Chapter
In: Makuuchi, Masatoshi; Kokudo, Norihiro; Popescu, Irinel; Belghiti, Jacques; Han, Ho-Seong; Takaori, Kyoichi; Duda, Dan G. (Ed.): The IASGO Textbook of Multi-Disciplinary Management of Hepato-Pancreato-Biliary Diseases, pp. 487–499, Springer Nature Singapore, Singapore, 2022, ISBN: 978-981-19-0063-1.
@inbook{Lerut2022,
title = {Deceased Donor Liver Transplantation: The Pendulum of Visions and Ideas},
author = {Jan Lerut and Quirino Lai},
editor = {Masatoshi Makuuchi and Norihiro Kokudo and Irinel Popescu and Jacques Belghiti and Ho-Seong Han and Kyoichi Takaori and Dan G. Duda},
url = {https://doi.org/10.1007/978-981-19-0063-1_64},
doi = {10.1007/978-981-19-0063-1_64},
isbn = {978-981-19-0063-1},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
booktitle = {The IASGO Textbook of Multi-Disciplinary Management of Hepato-Pancreato-Biliary Diseases},
pages = {487--499},
publisher = {Springer Nature Singapore},
address = {Singapore},
abstract = {During the second half of the twentieth-century, liver transplantation (LT) became a clinical reality. Many technical, medical, physiologic, and immunological hurdles needed to be taken to make this endeavour successful. Starzl stated already in 1989 that ``the conceptual appeal of liver transplantation would become so great that the procedure should come to mind as a last resort for virtually every patient with lethal hepatic disease.'' Technical perfection and the introduction in the 80s of the selective immunosuppressive drugs cyclosporine A and tacrolimus transformed LT into a routine procedure. Since then, signs of progress have been spectacular. The number of procedures applied to more than 50 different benign and malignant liver diseases has grown exponentially, reaching the 400,000 marks nowadays.},
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pubstate = {published},
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2019
Carlis L D; Carlis R D; Muiesan P
Past, present, and future of donation after circulatory death in Italy Journal Article
In: Updates in Surgery, vol. 71, no. 1, pp. 7 – 9, 2019, ISSN: 2038131X, (Cited by: 7; All Open Access, Bronze Open Access, Green Open Access).
@article{DeCarlis20197,
title = {Past, present, and future of donation after circulatory death in Italy},
author = {Luciano De Carlis and Riccardo De Carlis and Paolo Muiesan},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85063187518&doi=10.1007%2fs13304-019-00640-5&partnerID=40&md5=286f1cf3c66cfbc674776906c3c7d090},
doi = {10.1007/s13304-019-00640-5},
issn = {2038131X},
year = {2019},
date = {2019-01-01},
urldate = {2019-01-01},
journal = {Updates in Surgery},
volume = {71},
number = {1},
pages = {7 – 9},
publisher = {Springer-Verlag Italia s.r.l.},
note = {Cited by: 7; All Open Access, Bronze Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2018
Schlegel A; Kalisvaart M; Scalera I; Laing R W; Mergental H; Mirza D F; Perera T; Isaac J; Dutkowski P; Muiesan P
The UK DCD Risk Score: A new proposal to define futility in donation-after-circulatory-death liver transplantation Journal Article
In: Journal of Hepatology, vol. 68, no. 3, pp. 456 – 464, 2018, ISSN: 01688278, (Cited by: 119; All Open Access, Green Open Access).
@article{Schlegel2018456,
title = {The UK DCD Risk Score: A new proposal to define futility in donation-after-circulatory-death liver transplantation},
author = {Andrea Schlegel and Marit Kalisvaart and Irene Scalera and Richard W. Laing and Hynek Mergental and Darius F. Mirza and Thamara Perera and John Isaac and Philipp Dutkowski and Paolo Muiesan},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85040614271&doi=10.1016%2fj.jhep.2017.10.034&partnerID=40&md5=1644f5317bd2d8ad32a918be7dbf6c0f},
doi = {10.1016/j.jhep.2017.10.034},
issn = {01688278},
year = {2018},
date = {2018-01-01},
urldate = {2018-01-01},
journal = {Journal of Hepatology},
volume = {68},
number = {3},
pages = {456 – 464},
publisher = {Elsevier B.V.},
abstract = {Background & Aims: Primary non-function and ischaemic cholangiopathy are the most feared complications following donation-after-circulatory-death (DCD) liver transplantation. The aim of this study was to design a new score on risk assessment in liver-transplantation DCD based on donor-and-recipient parameters. Methods: Using the UK national DCD database, a risk analysis was performed in adult recipients of DCD liver grafts in the UK between 2000 and 2015 (n = 1,153). A new risk score was calculated (UK DCD Risk Score) on the basis of a regression analysis. This is validated using the United Network for Organ Sharing database (n = 1,617) and our own DCD liver-transplant database (n = 315). Finally, the new score was compared with two other available prediction systems: the DCD risk scores from the University of California, Los Angeles and King's College Hospital, London. Results: The following seven strongest predictors of DCD graft survival were identified: functional donor warm ischaemia, cold ischaemia, recipient model for end-stage liver disease, recipient age, donor age, previous orthotopic liver transplantation, and donor body mass index. A combination of these risk factors (UK DCD risk model) stratified the best recipients in terms of graft survival in the entire UK DCD database, as well as in the United Network for Organ Sharing and in our own DCD population. Importantly, the UK DCD Risk Score significantly predicted graft loss caused by primary non-function or ischaemic cholangiopathy in the futile group (>10 score points). The new prediction model demonstrated a better C statistic of 0.79 compared to the two other available systems (0.71 and 0.64, respectively). Conclusions: The UK DCD Risk Score is a reliable tool to detect high-risk and futile combinations of donor-and-recipient factors in DCD liver transplantation. It is simple to use and offers a great potential for making better decisions on which DCD graft should be rejected or may benefit from functional assessment and further optimization by machine perfusion. Lay summary: In this study, we provide a new prediction model for graft loss in donation-after-circulatory-death (DCD) liver transplantation. Based on UK national data, the new UK DCD Risk Score involves the following seven clinically relevant risk factors: donor age, donor body mass index, functional donor warm ischaemia, cold storage, recipient age, recipient laboratory model for end-stage liver disease, and retransplantation. Three risk classes were defined: low risk (0–5 points), high risk (6–10 points), and futile (>10 points). This new model stratified best in terms of graft survival compared to other available models. Futile combinations (>10 points) achieved an only very limited 1- and 5-year graft survival of 37% and less than 20%, respectively. In contrast, an excellent graft survival has been shown in low-risk combinations (≤5 points). The new model is easy to calculate at the time of liver acceptance. It may help to decide which risk combination will benefit from additional graft treatment, or which DCD liver should be declined for a certain recipient. © 2017 European Association for the Study of the Liver},
note = {Cited by: 119; All Open Access, Green Open Access},
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pubstate = {published},
tppubtype = {article}
}
2012
Monbaliu D; Pirenne J; Talbot D
Liver transplantation using Donation after Cardiac Death donors Journal Article
In: Journal of Hepatology, vol. 56, no. 2, pp. 474 – 485, 2012, ISSN: 01688278, (Cited by: 146; All Open Access, Hybrid Gold Open Access).
@article{Monbaliu2012474,
title = {Liver transplantation using Donation after Cardiac Death donors},
author = {Diethard Monbaliu and Jacques Pirenne and David Talbot},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84855929110&doi=10.1016%2fj.jhep.2011.07.004&partnerID=40&md5=7c743c10a5fa28cc76c9267b3bc03a51},
doi = {10.1016/j.jhep.2011.07.004},
issn = {01688278},
year = {2012},
date = {2012-01-01},
urldate = {2012-01-01},
journal = {Journal of Hepatology},
volume = {56},
number = {2},
pages = {474 – 485},
publisher = {Elsevier B.V.},
abstract = {The success of solid organ transplantation has brought about burgeoning waiting lists with insufficient donation rates and substantial waiting list mortality. All countries have strived to expand donor numbers beyond the standard Donation after Brain Death (DBD). This has lead to the utilization of Donation after Cardiac Death (DCD) donors, also frequently referred to as Non-Heart Beating Donors (NHBD). Organs from these donors inevitably sustain warm ischaemic damage which varies in its extent and affects early graft function as well as graft survival. As a consequence, 'non-vital' organs such as renal transplants have increased rapidly from DCD donors but more 'vital' organ transplants such as the liver have lagged behind. However, an increasing proportion of liver transplants are now derived from DCD donors. This article covers this expansion, current results, pitfalls, and steps taken to minimize complications and to improve outcome, and future developments that are likely to occur. © 2011 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.},
note = {Cited by: 146; All Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2002
Kootstra G; Kievit J; Nederstigt A
Organ donors: Heartbeating and non-heartbeating Journal Article
In: World Journal of Surgery, vol. 26, no. 2, pp. 181 – 184, 2002, ISSN: 03642313, (Cited by: 60; All Open Access, Bronze Open Access).
@article{Kootstra2002181,
title = {Organ donors: Heartbeating and non-heartbeating},
author = {Gauke Kootstra and Jur Kievit and Arjen Nederstigt},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-0036484260&doi=10.1007%2fs00268-001-0205-2&partnerID=40&md5=4e71e1c2679e64453c037ca2ef5eadbd},
doi = {10.1007/s00268-001-0205-2},
issn = {03642313},
year = {2002},
date = {2002-01-01},
urldate = {2002-01-01},
journal = {World Journal of Surgery},
volume = {26},
number = {2},
pages = {181 – 184},
abstract = {The limits of organ donation from heart-beating (HB) donors reached a plateau illustrated by the number of postmortem kidneys for transplantation. Programs such as the European Donor Hospital Education Program (EDHEP) and Donor Action have helped to stop a further decrease in the number instead of an expected increase. For kidneys, heart, liver, and lungs one must also explore the use of marginal donors as a possible additional source. Examples are donors with a horseshoe kidney, those at both ends of the age spectrum, and those with medical contraindication such as diabetes. We have enlarged our kidney donor pool considerably with non-heart-beating (NHB) donors. Because we preserve these kidneys in a preservation machine, we are able to perform viability testing. With glutathione S-transferase (GST) as a measure of tubular damage, we now decide whether to transplant based on GST values. For other organs, NHB donation does not seem to be an option other than for the liver when the warm ischemia time is short.},
note = {Cited by: 60; All Open Access, Bronze Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
