Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper
Avnish K Seth, Ravi Mohanka, Sumana Navin, Alla GK Gokhale, Ashish Sharma, Bala Ramachandran, KR Balakrishnan, Darius Mirza, Dhvani Mehta, Kumud Dhital, Manisha Sahay, Radha Sundaram, Rahul Pandit, Raj K Mani, Roop Gursahani, Subash Gupta, Vivek B Kute, Sunil Shroff
Circulatory death, Donation, Organ donation
Citation Information :
Seth AK, Mohanka R, Navin S, Gokhale AG, Sharma A, Ramachandran B, Balakrishnan K, Mirza D, Mehta D, Dhital K, Sahay M, Sundaram R, Pandit R, Mani RK, Gursahani R, Gupta S, Kute VB, Shroff S. Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper. Indian J Crit Care Med 2022; 26 (4):423-440.
Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries. In India, majority of deceased donations happen following brain death (BD). While existing legislation allows for DCDD, there have been only few reports of kidney transplantation following DCDD from India. This document, prepared by a multidisciplinary group of experts, reviews international best practices in DCDD and outlines the path for DCDD in India. Ethical, medical, legal, economic, procedural, and logistic challenges unique to India have been addressed. The practice of withdrawal of life-sustaining treatment (WLST) in India, laid down by the Supreme Court of India, is time-consuming, possible only in patients in a permanent vegetative state, and too cumbersome for day-to-day practice. In patients where continued medical care is futile, the procedure for WLST is described. In controlled DCDD (category-III), decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Families that are inclined toward organ donation are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand-down and return to the intensive care unit (ICU) without donation. In donation following neurologic determination of death (DNDD), if cardiac arrest occurs during the process of BD declaration, the protocol for DCDD category-IV has been described in detail. In DCDD category-V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the ICU. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and techniques, such as normothermic regional perfusion (nRP) and ex vivo machine perfusion, has been provided. The outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for successful execution of DCDD in India are described.
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