Current scenario of DCD Organs
Dr Anil Sharma
Amrita Hospital, Faridabad
Rising demand for organs has led to the inclusion of DCD organs in the deceased donor pool in various countries which has resulted in an increase in donation rates by various proportions in different countries. Despite initial concerns about the delayed graft function, it was clarified by various recent studies that DCD organs, including pediatric donors, have similar long-term outcomes in comparison to the brain dead donors.
Despite a recent surge in organ donation rates in India, the numbers remain dismal. Even though the law allows kidney donation after circulatory death (DCDD) is not common in India. The majority of deceased organ donations in India are after brain death (BD). First DCD kidney transplant was performed at IKDRC, Ahmedabad in 1999. Other than IKDRC and PGI Chandigarh, there are only a couple of sporadic DCD organ transplants from the rest of the country. Supreme Court Judgement on Aruna Shanbaug case in 2011 clarified that in an incompetent person parents, spouse, other close relatives or “next friend” were allowed to withdraw nutrition, water or Withdrawal of life support therapies (WLST) with court’s approval.
The Institute of Kidney Diseases and Research Centre (IKDRC), Ahmedabad performed 33 controlled donation after circulatory determination of death (cDCDD) kidney transplants between January 1999 and January 2012, constituting 10% of their total deceased donor transplants during that period. With standard immunosuppression, patient survival at 1 and 10 years was 87.3 and 72.8%, respectively and graft survival was 90.9% when the donors were younger than 70 years, with an acceptable delayed graft function (DGF) rate of 31%.
The Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh published their initial experience in 2022 and concluded that DCDD kidneys at their centre performed at par with the DCDD kidney retrieved elsewhere in the world despite the existing challenges in India. In their study 38 kidneys were retrieved and thirty-one (81.5%) kidneys were utilized. In the entire study period there were eight (three PNF and five after initial function) graft losses (28.5%) and the DCDD contribution to total donor pool stood at 6.8 % (28/411).
Thus, there are number of challenges to DCD in India and robust mechanism needs to be put in place to accelerate the DCD program and improve donor pool.
Challenges of DCD in India |
Ex-situ perfusion system - expensive - use limited |
Low awareness, spiritual beliefs |
Lack of clarity in the laws |
Guidelines for withdrawal of life support therapy complex |
Ethical issues |
Strategies to increase DCD |
Improvement in storage & perfusion techniques |
Family consent for withdrawal of care needs to be delinked from organ donation |
Improving infrastructure for organ retrieval & transplant |
Application of multidisciplinary approach - social workers, grief counsellors, transplant co-ordinators |
Local social, cultural and ethical aspects should be addressed by formulating policies |
Strengthening support to family, improving donor selection and early determination of impending death |
Clear guidelines for end of life care and withdrawal of life support therapies |
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