Organ retrieval from a donor after circulatory arrest – case report and review

Authors: Rusinová Kateřina 1,2;  Pokorná Eva 3;  Vávra Václav 1;  Kusová Dagmar 1;  Janoušek Libor 4;  Froněk Jiří 4;  Stach Zdeněk 1;  Turčianský Martin 1;  Otáhal Michal 1;  Doležal Adam 1;  Černý David 2;  Balík Martin 1;  Černý Vladimír 5,6
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice, Praha 1;  Ústav pro humanitní studia v lékařství, 1. lékařská fakulta Univerzity Karlovy, Praha 2;  Oddělení odběru orgánů a transplantačních databází, Transplantacentrum, Institut klinickéa experimentální medicíny, Praha 3;  Klinika transplantační chirurgie, Institut klinické a experimentální medicíny, Praha 4;  Fakultní nemocnice Hradec Králové, Klinika anesteziologie, resuscitace a intenzivní medicíny, Hradec Králové 5;  Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada 6
Published in: Anest. intenziv. Med., 25, 2014, č. 4, s. 301-306
Category: Intensive Care Medicine - Review Article


This case study reports the initial management, prognosis assessment and withdrawal of life support followed by retrieval of vital organs for transplantation in a patient admitted after out-of-hospital cardiac arrest. This is the first description of a case of controlled donation after circulatory death in the Czech Republic. We discuss in detail the practical aspects of organ retrieval management, the role of echocardiography in circulatory arrest, indication of palliative treatment including terminal weaning and determining death due to circulatory arrest. We also emphasize communication with family members. The protocol used to determine death after circulatory arrest is presented along with the basic ethical and legal considerations in this sub-group of organ donors.

irreversible circulatory arrest – death determinativ – transplant law – palliative care – echocardiography


1. Manara, A. R., Murphy, P. G., O’Callaghan, G. Donation after circulatory death. Br. J. Anaesth., 2012, 108, p. 108–121.

2. Ledinh, H., Bonvoisin, C., Weekers, L., de Roover, A., Hono-ré, P., Squifflet, J. P. et al. Results of kidney transplantation from donors after cardiac death. Transplant. Proc., 2010, 42, 7, p. 2407–2414.

3. Matsuno, N., Sakurai, E., Kubota, K., Kozaki, K., Uchiyama, M., Nemoto, T. et al. Evaluation of the factors related to early graft function in 90 kidney transplants from non-heart-beating donors. Transplant. Proc., 1997, 29, 8, p. 3569–3570.

4. Thornton, S. R., Hamilton, N., Evans, D., Fleming, T., Clarke, E., Morgan, J. et al. Outcome of kidney transplantation from elderly donors after cardiac death. Transplant. Proc., 2011, 43, 10, p. 3686–3689.

5. Reich, D. J., Hong, J. C. Current status of donation after cardiac death liver transplantation. Curr. Opin. Organ. Transplant., 2010, 15, 3, p. 316–321.

6. Dubbeld, J., Hoekstra, H., Farid, W., Ringers, J., Porte, R. J., Metselaar, H. J. et al. Similar liver transplantation survival with selected cardiac death donors and brain death donors. Br. J. Surg., 2010, 97, 5, p. 744–753.

7. Callaghan, C. J., Charman, S. C., Muiesan, P., Powell, J. J., Gimson, A. E., van der Meulen, J. H. P. et al. Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study. BMJ Open, 2013, 3, 9, p. e003287.

8. Salvalaggio, P. R., Davies, D. B., Fernandez, L. A., Kauf-man, D. B. Outcomes of pancreas transplantation in the United States using cardiac-death donors. Am. J. Transplant. Off. J. Am. Soc. Transplant. Am. Soc. Transpl. Surg., 2006, 6, 5, p. 1059–1065.

9. De Vleeschauwer, S. I., Wauters, S., Dupont, L. J., Verleden, S. E.,Willems-Widyastuti, A., Vanaudenaerde, B. M. et al. Medium-term outcome after lung transplantation is comparable between brain-dead and cardiac-dead donors. J. Heart Lung Transplant. Off. Publ. Int. Soc. Heart Transplant., 2011, 30, 9, p. 975–981.

10. De Oliveira, N. C., Osaki, S., Maloney, J. D., Meyer, K. C., Kohmoto, T., D’Alessandro, A. M. et al. Lung transplantation with donation after cardiac death donors: long-term follow-up in a single center. J. Thorac. Cardiovasc. Surg., 2010, 139, 5, p. 1306–1315.

11. Boucek, M. M., Mashburn, C., Dunn, S. M., Frizell, R., Edwards, L., Pietra, B. et al. Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death. N. Engl. J. Med., 2008, 14, 359, 7, p. 709–714.

12. Doporučení představenstva ČLK č. 1/2010. Dostupné na www:

13. Kootstra, G., Daemen, J. H., Oomen, A. P. Categories of non-heart-beating donors. Transplant. Proc., 1995, 27, 5, p. 2893–2894.

14. Kootstra, G., Kievit, J. K., Heineman, E. The non heart-beating donor. Br. Med. Bull., 1997, 53, 4, p. 844–853.

15. Wijdicks, E. F. M., Hijdra, A., Young, G. B., Bassetti, C. L., Wiebe, S. Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscita-tion (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2006, 25, 67, 2, p. 203–210.

16. Truog, R. D., Brock, D. W., White, D. B. Should patients re-ceive general anesthesia prior to extubation at the end of life? Crit. Care. Med., 2012, 40, 2, p. 631–633.

17. Wind, J., Faut, M., van Smaalen, T. C., van Heurn, E. L. Variability in protocols on donation after circulatory death in Europe. Crit. Care Lond. Engl., 2013, 3, 17, 5, p. R217.

18. Levvey, B. J., Westall, G. P., Kotsimbos, T., Williams, T. J., Snell, G. I. Definitions of warm ischemic time when using controlled donation after cardiac death lung donors. Transplantation, 2008, 27, 86, 12, p. 1702–1706.

19. Hoffenberg, R. Christiaan Barnard: his first transplants and their impact on concepts of death. BMJ, 2001, 22, 323, 7327, p. 1478–1480.

20. Zamperetti, N., Bellomo, R., Ronco, C. Defining death in non-heart beating organ donors. J. Med. Ethics., 2003, 29, 3, p. 182–185.

21. Salen, P., Melniker, L., Chooljian, C., Rose, J. S., Alteveer, J., Reed, J. et al. Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients? Am. J. Emerg. Med., 2005, 23, 4, p. 459–462.

22. Hornby, K., Hornby, L., Shemie, S. D. A systematic review of autoresuscitation after cardiac arrest. Crit. Care Med., 2010, 38, 5, p. 1246–1253.

23. Stiegler, P., Sereinigg, M., Puntschart, A., Seifert-Held, T., Zmugg, G., Wiederstein-Grasser, I. et al. A 10min “no-touch” time – is it enough in DCD? A DCD animal study. Transpl. Int. Off. J. Eur. Soc. Organ. Transplant., 2012, 25, 4, p. 481–492.

24. Zákon č. 44/2013 Sb. Dostupné na www:

25. Příloha č. 3 k vyhlášce č. 114/2013 Sb. Available from:

26. Joffe, A. R., Carcillo, J., Anton, N., deCaen, A., Han, Y. Y., Bell, M. J. et al. Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent. Philos Ethics Humanit. Med. (PEHM), 2011, 6, 17.

27. Truog, R. D., Miller, F. G. Counterpoint: are donors after circulatory death really dead, and does it matter? No and not really. Chest, 2010, 138, 1, p. 16–18, discussion p. 18–19.

28. Bernat, J. L. The debate over death determination in DCD. Hastings Cent. Rep., 2010, 40, 3, p. 3.

29. Bernat, J. L. Point: are donors after circulatory death really dead, and does it matter? Yes and yes. Chest, 2010, 138, 1, p. 13–16.

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