Introduction: The use of donors after circulatory death (DCD) has increased in recent years, specially after the use of normothermic regional perfusion (NRP) for all solid organs except the intestines, mainly due to its susceptibility to broader ischemic damage.
Method and results: Our team evaluated five multivisceral grafts from five potential pediatric DCD donors. Multivisceral grafts include intestines and, at least, two abdominal organs. In one case, the patient didn´t die at a time compatible with the donation. In another case, without heart recovery, the multivisceral graft was dismissed due to its appearance. The three remaining cases were actual organ donors, whose characteristics are shown in Table 1.
After making the decision to withdraw life support (LS), the possibility of donation was offered to the family. The patients were transferred to the operating room where, once everything had been prepared (surgical instruments, sterile field and ECMO (extracorporeal membrane oxygenation), the surgical team left the operating room. After that, the parents entered through a different door. Once the family had made their peace, intravenous heparin (3 mg/kg) was administered before the extubation. After withdrawing LS, significant hypoperfusion began. This happens when the mean arterial pressure is lower than 30mmHg in patients <1 year old, which is the case in all of our three patients. When the circulatory arrest happened, we asked gently for the parents to leave. Later, the surgical team went into the operating room using another door. According to spanish law, after five minutes, the death is confirmed. Simultaneous sternotomy and ligation of the supra-aortic trunks and cannulation of the infrarenal aorta and cava vein were performed. Following cannulation, NRP was started (the target flow is 2.6 L/min/m 2 ). The mean warm ischemia time (WIT) was 25,33 min (range 23-29). The heart spontaneously began to beat after starting ECMO without the need for defibrillation, at a mean time of 1,33 minutes (range 1-2 min). The patients were reintubated and vasopressor support was started. The multivisceral grafts presented good perfusion. In this situation, the ECMO flow was decreased progressively until withdrawal 23,33 min later. The procurement was similar to that of brain death donors. Multivisceral grafts were implanted without any incident in recipients with intestinal failure and liver disease. Two recipients were discharged from the hospital. The most recent transplant recipient died two weeks after the transplant.
Conclusion: DCD is a possible source of organ donation also in the case of multivisceral grafts.