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Donation after Euthanasia (DCD-V) Results in Excellent Long-Term Outcome after Lung Transplantation, Equal to Donation after Brain Death (DBD) and Circulatory Death (DCD-III).

Journal Contribution - Journal Article

PURPOSE: In countries with a legal framework for physician-assisted death, organ donation after euthanasia (DCD-V) can increase the donor pool. DCD-V grafts are characterized by absence of lung injury related to brain-death, intubation and a long agonal phase. We review our experience with LTx after DCD-V and compare outcome with DBD and DCD-III experience in the same era. METHODS: Between 01/2007-09/2019, 797 LTx were performed, of which 158 from DCD donors, including 20 DCD-V {8M/12F; mean age (range): 50 (28-66y)} due to neuromuscular (8) / mental (9) disorder or untreatable pain (3). After the request for euthanasia was granted in accordance with legislation, an explicit wish for organ donation was expressed by the patient and approved by the Institutional Review Board. Euthanasia was carried out in-hospital (local: 4; remote: 16) adjacent to the operating room in absence of the retrieval team. RESULTS: Twenty patients {7M/13F; age: 53y (27-64)} underwent bilateral LTx for emphysema (n=10), pulmonary fibrosis (n=5), cystic fibrosis (n=3, liver transplant in 1) and bronchiolitis obliterans (n=2). Waiting time was 326d (34-662). Agonal phase was short: 3min (0-14). Warm ischemia time between circulatory arrest and flush was 12min (7-21). Intensive care unit and hospital stay were 6d (2-10) and 28d (16-44). Three patients died due to cardiac problem (3mo), haematological disorder (3mo) or aspergillosis (10y). Follow-up was 4y (2mo-10.5y), CLAD occurred in 4. Five-year patient survival for DCD-V was 89%, equaling the DBD {80% (p=0.68)} and DCD-III cohort {81% (p=0.78)}. CLAD-free survival was 66.7%, equal to DBD {68.2% (p=0.68)} and DCD-III {69.9% (p=0.91)}. CONCLUSION: Our series represents the largest LTx experience from DCD-V and demonstrates for the first time that long-term outcome is comparable with DBD and DCD-III. DCD-V can further expand the donor pool in nations with a legal framework for physician-assisted death.
Journal: JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN: 1053-2498
Issue: 4S
Volume: 39
Pages: S140 - S141
Publication year:2020