Donation after Circulatory Death (DCD)

Organ transplantation improves the quality of life and increases the life expectancy of patients with end- stage organ failure. The Belgian law supports the opting out system to approach possible donors. As a consequence and due to governmental campaigns,the number of brain death donors per million inhabitants in Belgium is amongst the highest in the world. Still patients do not reach transplantation as the number of patients on the waiting list outnumbers the amount of organs available. Therefore alternative sources of organs need to be sought. Living organ donation, splitting of organs… could contribute and diminish the gap between the number of listed and transplanted patients. These sources will not be covered in this document. “Non Heart Beating Donors (NHBD)” or in a more recent and international definition “Donors after Circulatory Death (DCD)” are a potential and additional group of deceased persons, being able to add organs to the pool. DCD describes the recovery of organs for the purposes of transplantation that follows death confirmed using circulatory criteria. This differs in respect with the actual model for deceased donation, which is the donation after the confirmation of death using neurological criteria (“Heart beating donation (HBD)” or “Donation after Brain Death (DBD)”). In the beginning of the era of transplantation, the most of the donors were DCD, whereas later (and due to better outcome), DBD became the standard. Recent re –interest rose in DCD donors, as a consequence of better preservation techniques and a better insight in different categories of DCD donors (the so-called Maastricht classification). In recent literature, more and more data are available that the results after organ (kidney, liver, lung…) transplantation using DCD are acceptable or good. Also in Belgium, different organs were transplanted with DCD donors. Since organ donation is based on a broad platform (general society and professionals), it is important to communicate on this in a transparent and uniform manner. Therefore the Belgian Transplant Council and the Belgian Transplantation Society organized a working group on DCD covering its aspects (Legal and ethical aspects, aspects about retrieval and perfusion, surgical aspects…). This working group consisted out of experts from all universities and university hospitals and from experts of some nonuniversity hospital. This document is the result of several meetings and is the result of a consensus between the experts