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Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes
INTRODUCTION: 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 be...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495857/ https://www.ncbi.nlm.nih.gov/pubmed/26104293 http://dx.doi.org/10.1186/s13054-015-0985-7 |
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author | Ortega-Deballon, Iván Hornby, Laura Shemie, Sam D. |
author_facet | Ortega-Deballon, Iván Hornby, Laura Shemie, Sam D. |
author_sort | Ortega-Deballon, Iván |
collection | PubMed |
description | INTRODUCTION: 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Scholar electronic databases from 2005 to March 2015 as well as the reference lists of selected studies, abstracts, unpublished reports, personal libraries, professional organization reports, and government agency statements on uDCD.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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0985-7) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4495857 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-44958572015-07-09 Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes Ortega-Deballon, Iván Hornby, Laura Shemie, Sam D. Crit Care Research INTRODUCTION: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-0985-7) contains supplementary material, which is available to authorized users. BioMed Central 2015-06-24 2015 /pmc/articles/PMC4495857/ /pubmed/26104293 http://dx.doi.org/10.1186/s13054-015-0985-7 Text en © Ortega-Deballon et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Ortega-Deballon, Iván Hornby, Laura Shemie, Sam D. Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes |
title | Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes |
title_full | Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes |
title_fullStr | Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes |
title_full_unstemmed | Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes |
title_short | Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes |
title_sort | protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495857/ https://www.ncbi.nlm.nih.gov/pubmed/26104293 http://dx.doi.org/10.1186/s13054-015-0985-7 |
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