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Organ Donation in DCD: 10 Year Experience at the University o f Michigan

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  1. Organ Donation in DCD: 10 Year Experience at the University of Michigan A Rojas-Pena, MD; L Sall, BS; K. Koch, BS; E Cooley, RN; M Gravel, RN; R Bartlett, MD; J Punch, MD; S Pelletier, MD University of Michigan Health System Department of Surgery, Section of Transplantation and the Extracorporeal Life Support Program

  2. DCD History at UM Large transplant program + large extracorporeal life support (ECS) program • 2000, both programs were combined Extracorporeal support (ECS)  resuscitate and recover abdominal organs in controlled DCD (Maastricht category III) when the family requests organ donation • Successful recovery / transplantation of kidneys, liver and pancreas • Initial experience reported in 2005 with 20 ECS-DCD Magliocca, et al. The Journal of trauma 2005;58(6):1095-101; discussion 1101-2.

  3. Objectives • Retrospective review of DCD program: • 10-year experience • cases between October 2000 to August 2010 • Update UM first series study on ECS assisted donation in controlled DCD ECS-cDCD

  4. Methods • Potential cDCD abdominal organs OK for procurement after dead • Recipient outcome data of: • Kidneys and livers procured and transplanted at UM only • RR technique (RR-DCD group) vs • ECS technique (ECS-DCD group)

  5. DCD selection • <65yo / Maastricht type III • Severe irreversible brain injury  NO BD criteria • Intensive Care Unit (ICU) on MV and/or life support • Cardio-circulatory arrest after planned withdrawal of life support • Family for donation • Consent for cannulation • No contraindications to transplant grafts

  6. UM – ECS circuit

  7. Final DCD at UM 37 ECS-DCD & 25 RR-DCD

  8. ORPD & OTPD Rates January-June 2011 DCD: 2.45 ORPD & 2.0 OTPD / Discard rate: 18%

  9. Summary of the ECS run

  10. ECS-DCD Complications

  11. UM Outcomes Renal Grafts • 37 patients (5 yr follow up) DGF: Need of HD within the first week post-transplantation - 50% due to hyperkalemia

  12. Graft Survival Rates US graft survival rate: 89% 66% 77%

  13. Outcomes Livers • 20 DCD liver recipients • Full records / HIPPA (3 year follow up) • Recipient MELD score = 15-17 Ischemic cholangiopathy: 15% (both groups)

  14. Take Home Message

  15. Acknowledgments ECLS Program Staff • Pula Baldridge, RN • Manager • Sheri Bignall Faculty • Jonathan Haft • ECLS Director • Gail Annich • ECLS co-Director • George Mychaliska • Robert Bartlett ECLS Lab • Lauren Sall • Kelly Koch Transplant Team • Jeff Punch • Director Transplant Program • Swan Pelletier • Larry Slate II • Chief Transplant perfusionist