What Is a DCD Liver Transplant?

Most livers used for transplant come from brain dead donors (donation after brain death, or DBD). Because of the shortage of livers donated after brain death, livers from donors whose hearts stop beating before donation (donation after cardiac death, or DCD) are being used.

Purpose

DCD is used to increase the number of available livers for transplant. More than 16,000 transplant candidates are on the transplant list, according to a report from Elsevier Global Medical News on the 2009 meeting of the Central Surgical Association in Sarasota, Florida.

Process

The liver is removed after the patient has suffered cardiac arrest. Because the heart has stopped beating, no blood flows through the liver and it receives no nutrients until it's removed from the donor and artifically re-perfused.

Benefits

The benefit of DCD is that more livers qualify for donation. A University of Pennsylvania study in Transplantation 2008 showed no difference in survival rates after one to three years between DCD and DBD livers.

Risks

A study reported by Dr. Robert Merion of the University of Michigan Health System in the October 2006 issue of Annals of Surgery found a post-transplant increase in liver failure (graft failure) after transplant at one and three years. At the Central Surgical Association meeting in 2009, Dr. Anton Skaro of Northwestern University reported an increase in complications in patients who received DCD transplants.

Concerns

Studies are contradictory on whether DCD livers are as beneficial for recipients as DBD livers. Debate continues on whether recipients do better if they receive DCD livers as opposed to waiting for DBD livers, according to Dr. Merion, whose article also states that 2,000 people on the transplant list died without receiving a liver in 2007.

References

• Annals of Surgery; Donation After Cardiac Death as a Strategy to Increase Deceased Donor Liver Availability; Robert M. Merion, MD; 2006
• Central Surgical Association annual meeting; Liver donation after cardiac death; 2009
• Transplantation; Successful donation of Donation-after-cardiac-death-liver; L Matsuoka ; 2006