title: Livers transplanted from donors after cardiac death occurring in the ICU or the operating room have excellent outcomes.
abstract: BACKGROUND
  Increasing donor hospital cooperation with donation after cardiac death (DCD) requires the organ procurement organization (OPO) to use current withdrawal of life support (WLS) protocols. Hospital ICU nurses/physicians are comfortable performing the emotionally draining procedure of WLS in the ICU while OPOs are reluctant to accept these donors due to increased warm ischemia (WI). In our area, several hospitals will only allow WLS to occur in the ICU. This study compares liver outcomes from DCD donors where death occurred in the ICU (DCDICU) vs the OR (DCDOR).
  
  
  METHODS
  From March 2003 to June 2004, 34 DCD donors were recovered by our OPO. WLS occurred in the ICU for 26 donors (76%) and in the OR for 8 donors (24%). Thirteen of 26 DCDICU and 5 of 8 DCDOR livers were transplanted. Donor demographics, warm ischemic time, cold ischemic time, distance shipped, and recipient functions were analyzed.
  
  
  RESULTS
  Eighteen livers were transplanted both locally and at distant transplant centers. Results are outlined in the .
  
  
  CONCLUSIONS
  Although DCDICU donors averaged approximately 4 minutes longer WI than DCDOR donors, short-term results for both groups were equivalent. These findings support using DCDICU livers. DCDICU donors have the potential to significantly improve donor hospital cooperation.
authors.affiliation: LifeCenter Northwest, Bellevue, Washington 98004, USA. leso@lcnw.org
authors.forename: L
authors.initials: L
authors.lastname: Olson
authors.forename: J
authors.initials: J
authors.lastname: Kisthard
authors.forename: L
authors.initials: L
authors.lastname: Cravero
authors.forename: J
authors.initials: J
authors.lastname: Fung
authors.forename: B
authors.initials: B
authors.lastname: Eghtesad
authors.forename: A
authors.initials: A
authors.lastname: Savo
authors.forename: A
authors.initials: A
authors.lastname: Levy
authors.forename: N
authors.initials: N
authors.lastname: Polissar
authors.forename: W
authors.initials: W
authors.lastname: Marks
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002423:Cause of Death; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin