Non-heart-beating donation

Prior to the introduction of brain death into law in the mid to late 1970s, all organ transplants from cadaveric donors came from non-heart beating donors (NHBDs).

Donors after brain-dead (DBD) (beating heart cadavers), however, led to better results as the organs were perfused with oxygenated blood until the point of perfusion and cooling at organ retrieval, and so NHBDs were generally no longer used except in Japan, where brain death was not legally, until very recently, or culturally recognized.

However, a growing discrepancy between demand for organs and their availability from DBDs has led to a re-examination of using non-heart beating donors, donors after circulatory death (DCDs), and many centres are now using such donors to expand their potential pool of organs.

Tissue donation (corneas, heart valves, skin, bone) has always been possible for non-heart beating donors, and many centres now have established programmes for kidney transplants from such donors. A few centres have also moved into DCD liver and lung transplants. Many lessons have been learnt since the 1970s, and results from current DCDs transplants are comparable to transplants from DBDs.

NHBDs are grouped by the Maastricht classification:

Categories I, II, IV and V are termed uncontrolled and category III is controlled.

As of yet, only tissues such as heart valves, skin and corneas can be taken from category I donors. Category II donors are patients who have had a witnessed cardiac arrest outside hospital, have cardiopulmonary resuscitation by CPR-trained providers commenced within 10 minutes but who cannot be successfully resuscitated. Category III donors are patients on intensive care units with non-survivable injuries who have treatment withdrawn; where such patients wished in life to be organ donors, the transplant team can attend at the time of treatment withdrawal and retrieve organs after cardiac arrest has occurred.

Kidneys can be used from category II donors, and all organs except the heart can potentially be used from category III, IV and V donors. An unsuccessful kidney recipient can remain on dialysis, unlike recipients of some other organs, meaning that a failure will not result in death.

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Wikipedia