Non-heart-beating donors: State of the art

Abstract

Due to persistent mismatch between transplant indications and available grafts, a transplantation program for non-heart-beating donors (NHBD) has been implemented in France since 2005. NHBD program includes two separate entities: “controlled” and “uncontrolled” NHBD. If in both cases, the heart is not beating, controlled NHBD are patients admitted in the intensive care unit and for whom a decision of treatment withdrawal was undertaken (Maastricht III); while uncontrolled NHBD are donors who experienced unexpected cardiac arrest, often out of the hospital, with no return of spontaneous activity (Maastricht I and II). Due to ethical concerns, controlled NHBD are not allowed in France. Organ retrieval from uncontrolled NHBD needs significant technical organization to minimize duration of warm ischemia. Only kidneys, liver, and tissues retrieval from “uncontrolled” NHBD are allowed in France. To minimize the risk of primary organ non-function, criteria for selection of donors and recipients as well as deadlines to limit duration of warm ischemia are restrictive. When all these criteria are respected, transplantation results are similar with organs obtained from NHBD and brain-dead donors.