J Korean Med Sci.  2021 Jun;36(23):e171. 10.3346/jkms.2021.36.e171.

First Organ Donation after Circulatory Death Following Withdrawal of Life-sustaining Treatment in Korea: a Case Report

Affiliations
  • 1Transplantation Center, Korea University Anam Hospital, Seoul, Korea
  • 2Department of Critical Care Medicine & Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
  • 3Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
  • 4Korea Organ and Tissue Donation Agency, Seoul, Korea
  • 5Division of Acute Care Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

Abstract

In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist. The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of “no-touch time,” circulatory death was declared. Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.

Keyword

Donation after Circulatory Death; Withdrawal of Life-sustaining Treatment
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