The first liver transplantation from infant donors after cardiac death in China

Donation after cardiac death (DCD) represents an attractive strategy for remedying organ shortage (1). In 2007, China implemented the Regulation on Human Organ Transplantation, which was the first step toward the establishment of a voluntary organ donation system. Since then, the implementation of DCD programs within adult hospitals has substantially increased over the last two yr (2). In this short article, we describe our initial experience with a successful liver donation from an infant donor after cardiac death and discuss strategies for encouraging pediatric liver transplantation using pediatric liver from DCD in China. The donor was a 16-month-old girl (weight 10 kg, blood group A, rh(+)), who was admitted to our hospital because of irreversible anoxic cerebral damage after sudden asphyxiation. On admission, she was in a deep coma and was rescued in the pediatric intensive care unit (PICU). After 3 days of intensive care, asystole occurred after withdrawal from ventilation. The family addressed their wish of voluntary organ donation and initiated conversation about DCD with a physician and representative from the organ procurement organization. According to the stricter selection criteria, this patient fell into Maastricht category III. Consent was obtained for all necessary tests and procedures by the Red Cross coordinator. During the time that consent was obtained, the family was fully informed about the procedure, including any medications that may be given such as phentolamine and heparin. Consent was also obtained before withdrawal of life support for the placement of femoral arterial and venous cannulas that are inserted with local anesthesia once death was declared. The Red Cross coordinator was present throughout the process, as she or he had ongoing discussions with the family. But in order to avoid a conflict of interest, the coordinator was not involved in the management of the patient. The family was provided with support in the form of social work during withdrawal and after they left the operating room (3). The liver was transplanted as a whole organ to the recipient, a twoyr-old girl. The liver was reperfused via the recipient portal vein in seven. Biliary drainage was achieved by choledocho-choledostomy. There were no episodes of primary non-function post-operatively as well as biliary or vascular complications. At six months follow-up, her liver function tests were completely normal. Currently, DCD occurs in the PICU, where a pediatric intensive care unit attending who was not associated with the transplant team, withdraws support and pronounces the patient dead based on the confirmation of cardiac asystole, apnea, and unresponsiveness for two min. Cardiac asystole was determined by the absence of a pulsatile waveform on arterial pressure monitoring and verified by absent heart tones on auscultation and flat-line on electrocardiography. The family members left the PICU after the child died (4). Once death was declared after cardiopulmonary criteria, an additional five min should elapse before solutions are infused, as described in the 1997 Institute of Medicine Guidelines. The lack of dead donors continues to inhibit the development of organ transplantation, and it was imperative to have public discourse on DCD and hospital-based policies need to be developed in pediatrics. In this article, we present data on pediatric DCD procurement and thereby give some perspective on the direct impact that pediatric DCD organ donation has had on organ availability for the patient population in China s social and economic environment (5). In 2009, the platform for organ transplantation in our institute was established. The potential donors Pediatr Transplantation 2012: 16: 907–908 2012 John Wiley & Sons A/S.