Korean J Transplant.  2020 Dec;34(4):302-307. 10.4285/kjt.20.0028.

Liver transplantation from a non–heartbeating donor

• Na BG
• Hwang S
• Hong SK
• Jung DH
• Song GW
• Ha TY
• Ahn CS
• Moon DB
• Kim M
• Kim SH
• Lee SG

• KMID: 2510270
• DOI: http://doi.org/10.4285/kjt.20.0028

Abstract

Interest in utilizing organs from non–heart-beating donors (NHBDs) has increased be-cause of the organ shortage. However, liver transplantation (LT) from NHBDs has been scarcely performed in Korea because only Maastricht category IV is legally permitted. We present one case of LT from an NHBD with extracorporeal membrane oxygenation (ECMO) support. The case was a 42-year-old male patient with alcoholic liver cirrhosis. The model for end-stage liver disease score was 28. The donor was a 47-year-old female who was diagnosed with brain death due to cerebral infarct, but cardiac arrest occurred before brain death was finally confirmed. Thus, venous-arterial type ECMO was initiat-ed for circulatory support. In the operating room, asystole developed just after ECMO was stopped. After waiting for 5 minutes, cardiac death was declared. It took 6 minutes from skin incision to aorta perfusion. The recipient hepatectomy and graft implantation were performed according to the standard procedures of adult whole LT. The patient recovered from LT uneventfully and has been doing well for 9 years after LT. The use of NHBDs is a method to increase the potential pool of organ donors, thus changes toward enhanced public awareness and acceptance of donating organs, and legal support at the government level are necessary.

Keyword

Brain death; Donation after cardiac death; Cardiac arrest; Maastricht criteria; Deceased donor

Figure

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  Fig. 1 Computed tomography (CT) findings. (A) Pretransplant CT scan shows overt liver cirrhosis. (B) CT scan taken at 1 week after transplantation shows no significant abnormality. (C) CT scan taken at 2 years after transplantation shows a cystic mass in the central part of the liver. (D) CT scan taken at 8 years after transplantation shows no abnormal findings.

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  Fig. 2 Computed tomography findings of the donor’s brain. It was taken for the initial diagnosis of intracranial hemorrhage.

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  Fig. 3 The time sequence of process for donation after cardiac death. BP, blood pressure; ECMO, extracorporeal membrane oxygenation.

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  Fig. 4 Gross photograph of the explanted liver. There existed macronodular liver cirrhosis compatible with alcoholic liver cirrhosis.

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