title: Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes.
abstract: BACKGROUND
  A chronic shortage of organs remains the main factor limiting organ transplantation. Many countries have explored the option of uncontrolled donation after circulatory death (uDCD) in order to expand the donor pool. Little is known regarding the variability of practices and outcomes between existing protocols. This systematic review addresses this knowledge gap informing policy makers, researchers, and clinicians for future protocol implementation.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and Google Scholar electronic databases from 2005 to March 2015 as well as the reference lists of selected studies, abstracts, unpublished reports, personal libraries, professional organization reports, and government agency statements on uDCD. We contacted leading authors and organizations to request their protocols and guidelines. Two reviewers extracted main variables. In studies reporting transplant outcomes, we added type, quantity, quality of organs procured, and complications reported. Internal validity and the quality of the studies reporting outcomes were assessed, as were the methodological rigour and transparency in which a guideline was developed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015258).
  
  
  RESULTS
  Six guidelines and 18 outcome studies were analysed. The six guidelines are based on limited evidence and major differences exist between them at each step of the uDCD process. The outcome studies report good results for kidney, liver, and lung transplantation with high discard rates for livers.
  
  
  CONCLUSIONS
  Despite procedural, medical, economic, legal, and ethical challenges, the uDCD strategy is a viable option for increasing the organ donation pool. Variations in practice and heterogeneity of outcomes preclude a meta-analysis and prevented the linking of outcomes to specific uDCD protocols. Further standardization of protocols and outcomes is required, as is further research into the role of extracorporeal resuscitation and other novel therapies for treatment of some refractory cardiac arrest. It is essential to ensure the maintenance of trust in uDCD programs by health professionals and the public.
authors.affiliation: Canadian National Transplant Research Program, Montréal, Canada. iviortega@gmail.com.|Research Institute McGill University Health Centre, Montréal, Canada. iviortega@gmail.com.|Centre de Prélèvement d'Organes and Laboratoire de Simulation, Hôpital du Sacré-Cœur, Montréal, Canada. iviortega@gmail.com.|Faculty of Medicine and Health Sciences, Alcalá de Henares, Madrid, Spain. iviortega@gmail.com.|Helicopter Emergency Medical Service (SUMMA 112), Madrid, Spain. iviortega@gmail.com.|Critical Care Division, Montreal Children's Hospital, Office C-806, 2300, Rue Tupper, Montreal, QC, H3H 1P3, Canada. iviortega@gmail.com.
authors.forename: Iván
authors.initials: I
authors.lastname: Ortega-Deballon
authors.affiliation: DePPaRT Study, Pediatric Critical Care, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada. lhornby@uottawa.ca.|Deceased Donation, Canadian Blood Services, Ottawa, Canada. lhornby@uottawa.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Hornby
authors.affiliation: Deceased Donation, Canadian Blood Services, Ottawa, Canada. sam.shemie@mcgill.ca.|Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada. sam.shemie@mcgill.ca.|McGill University, Montreal, Canada. sam.shemie@mcgill.ca.
authors.forename: Sam D
authors.initials: SD
authors.lastname: Shemie
mesh_terms: D016757:Death, Sudden, Cardiac; D015199:Extracorporeal Membrane Oxygenation; D006085:Graft Survival; D006801:Humans; D017410:Practice Guidelines as Topic; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000331:legislation & jurisprudence