心死亡供者器官移植历史和现状

History of cardiac death organ donation and transplantation

世界范围的供者器官极度短缺已经成为制约器官移植发展的主要问题。心死亡供者(DCD)既往又称为无心跳供者,20世纪60年代开始应用于临床。由于移植技术和器官保存技术的提高,DCD在30年后再次引起世界移植界的广泛关注。既往有大量的DCD来源的肾、肝、肺和胰腺移植的成功报道,但对除肾以外的其他器官移植的评价都比较负面。近期一些关于移植物和受者长期随访的数据令人兴奋,值得探讨。本文就DCD来源器官移植的历史和现状作一综述。

Global shortage of suitable donor organs continues to adversely affect mortality rate in candidates on the waiting list for organ transplantation.Methods and techniques for expanding the donor pool for transplantation include the use of split and living donor allografts,extended criteria or marginal donors,and donors of cardiac death (DCD),meanwhile multiple incentives to improve living and cadaveric donation rates are under study.Organs from DCD donors are recovered after cessation of cardiopulmonary function in the donor,and can occur in a controlled setting,after a planned withdrawal of life support,or in an uncontrolled situation with the onset of sudden cardiac arrest.Although liver,kidney,lung,and pancreas grafts have been procured from DCD donors and successfully transplanted,long-term graft and patient survival rates from these procedures have been reviewed only recently.The comfort and healing nature of being able to leave a legacy of life through organ donation is well known and should never be underestimated whether donation occurs in the DCD or brain-death setting.In this article,the history of DCD organ donation is reviewed.