Death after Cardiac Death (DCD) organs, a form of expanded criteria organs, have traditionally been associated with greater complications. Generally, organs are given to pediatric cases preferentially though this has not been the case with expanded criteria organs for fear of increased organ failure. This study examined the outcome of allDCD liver and kidney transplants in pediatric cases over a ten year period and finds the results optimistic . It should be noted that the samples sizes were very small warranting the authors to conclude that “with selective use and in the correct setting, liver and kidney recipients can expect durable results.” As with any small sample size, a larger study would be necessary to obtain valid statistical results.

This study shows positive results from patients who received deceased after cardiac death (DCD) kidneys and livers. DCD organs are from potential donors who have sustained irreversible neurological injury, but do not meet formal brain death criteria (DBD). Often these patients succumb to their injuries when mechanical support is removed thus DCD organs have sustained some injury. DCD kidney recipients and their kidneys had comparable survival rates to DBD recipients. DCD liver recipients and their livers had slightly decreased three year survival rates. Both options prove to be far better than those patients on the recipient waiting list who did not receive organs. Use of DCD organs in the US is relatively new and thus a very small percentage of the total number of organs donated (3% of kidneys and 1.4% of livers), which could affect these results. Two other liver options, split livers (when one adult liver may be shared approx. 60 – 40% between two recipients) and livers from donors above 60 years of age are compared to DCD livers.

Note highlighted areas. Several doctors respond to the preceding article, “The Diagnosis of Brain Death,” which appeared in the New England Journal of Medicine in April, 2001.

This review focuses on the how doctors determine brain death, the potential confusing factors, and discusses valid confirmatory tests. Brain-stem death implies total loss of function to the part of the brain responsible for spontaneous breathing, maintaining blood pressure, cough reflex, pupil dilation, and to some extent heart rate. When these reflexes do not work, a spontaneous breathing test (apnea test) is performed. Finally, confirmatory tests proving a lack of blood flow to the brain-stem and absence of brain electrical activity are performed. At this time, the patient’s family should be told about their loved one’s hopeless condition and options for organ donation discussed. A few important notes: 1) reflex testing on infants and children is more complicated because their reflexes may not be fully formed 2) even after a patient fails reflex tests, spontaneous movements have been documented; these are spinal movements and not an indication of brain function 3) patients must be ruled out for locked-in syndrome (an almost total paralysis of a conscious patient with partial control of eye movements), hypothermia, drug intoxication, and, in some severe cases, Guillain-Barre Syndrome (a rare paralysis starting at the feet and rising over a few days).

This is the protocol used in Ontario Canada by physicians to determine brain death.