title: Time to death after withdrawal of treatment in donation after circulatory death (DCD) donors.
abstract: OBJECTIVE
  Controlled donation after circulatory death (DCD) donors make an important contribution to organ transplantation but there is considerable scope for further increasing the conversion of potential to actual DCD organ donors. The period between withdrawal of life-supporting treatment and death (the withdrawal period) is a major determinant of whether organ donation proceeds and it is therefore timely to review recent relevant studies in this area.
  
  
  RESULTS
  The duration and haemodynamic nature of the withdrawal period is extremely variable, and clinical guidelines for management of the potential donor during this period differ widely. Recent evidence suggests that kidneys from DCD donors with a prolonged withdrawal period can be used to increase the number of transplants performed and provide satisfactory graft function, suggesting that it is not the duration but the haemodynamic profile of the donor during this phase that are important. This suggestion questions the relevance of clinical indices predicting death within 1 h of treatment withdrawal.
  
  
  CONCLUSIONS
  Future studies should aim to define clinical and physiological variables during the withdrawal period that can be used to maximize well tolerated use of organs from potential DCD donors; these thresholds are likely to differ according to organ type.
authors: Department of Surgery, University of Cambridge, and Cambridge NIHR Biomedical Research Centre, Cambridge, United Kingdom. jab52@cam.ac.uk
authors: J A
authors: JA
authors: Bradley
authors: G J
authors: GJ
authors: Pettigrew
authors: C J
authors: CJ
authors: Watson
mesh_terms: D003643:Death; D046148:Donor Selection; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D016377:Organ Transplantation; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D028761:Withholding Treatment