Liver Transplantation Using Donors After Cardiac Death

The rising number of transplant candidates and scarcity of brain-dead donors promoted the research of strategies to increase graft supply, including the use of donor after cardiac death (DCD) livers. The damage from additional warm ischemia time (DWIT), increased primary nonfunction (PNF), ischemic-type biliary strictures (ITBS) and absence of universal algorithms for selecting grafts and ideal recipient-donor matching remain a problem. DCDs are classified as controlled and uncontrolled. Uncontrolled donors potentially constitute a larger pool, but require additional teams and equipment. DWIT is difficult to estimate and outcomes of liver grafts are inferior to those from donors after brain death (DBD). The shift toward controlled donation, better selection criteria, shorter DWIT and cold ischemia time (CIT) yielded results in some centers that are comparable to those in the DBD setting. Currently ITBS remains the main cause of inferior long-term graft survival. Additional work is required to better define which DCD grafts would be most suitable for transplantation, acceptable limits of warm and cold ischemia, and recipient selection criteria. © 2012 Blackwell Publishing Ltd.