Policies towards donation after circulatory death liver transplantation : the need for a guideline?

Background: Liver transplantation (LT) using grafts from donation after circulatory death (DCD) is evolving to standard of care in many countries. Various transplant centers have developed a protocol for DCD-LT. The existence of numerous protocols may cause inconsistencies. Knowledge of these differences may help improve the outcome of DCD-LT. Methods: An internet-based survey was sent to 119 transplant surgeons among four countries: Belgium (BE), the Netherlands (NL), Spain (ES) and the United Kingdom (UK). Results: Thirty-three percent of all respondents indicated having no specific age limit for DCD-LT donors, and if there was a limit, half of them ignored it. Calculation of donor warm ischemia time (dWIT) varied substantially between countries. In ES and the UK, the starting point of dWIT was defined as deterioration of saturation/blood pressure, while in NL, cardiac arrest was used as starting point. Seventy-eight percent of the respondents used a super-rapid sterno-laparotomy as procurement technique. Surgeons from NL and BE mainly used aortic perfusion (95% and 72%), while dual perfusion was more common in the UK (90%) and ES (91%). Conclusions: This study demonstrates major differences in approach to DCD-LT. To assure both donors and recipients a consistent standard of care, a consensus meeting on DCD-LT is highly recommended.