Non-heartbeating donors: Special considerations for procurement and preservation in liver transplantation

Purpose of review: The purpose of this article is to briefly review the current state of the art in the field of organ procurement and preservation as it pertains to non-heartbeating donors, or donation after cardiac death. Recent findings: The increasing organ shortage and death rate on the waiting lists has required transplant professionals, especially surgeons, to look for organs in the so-called extended donor pool. Although the procurement of kidneys from the donors after cardiac death was not uncommon, only recently have livers from these donors been considered for transplantation. Concerning this extended pool, there is an ever-growing body of literature, mostly based on data from single-transplant centers and single organ procurement organizations, emphasizing the safety and feasibility of using livers from donors after cardiac death. Initial function seems to be the same in livers from standard brain-dead donors as in livers from donors after cardiac death; however, some centers (but not others) have reported increased biliary complications in these donor livers compared with livers from standard brain-dead donors. The keys to success may lie in uniformity of procurement and preservation techniques as well as consensus about tolerable ischemic times. Summary: Despite concerns for long-term graft function, the use of livers from donors after cardiac death yields survival rates equivalent to those of livers procured from standard brain-dead donors.