Derivation and implementation of a protocol in Israel for organ donation after cardio-circulatory death

Background: Strategies aimed at expanding the organ donor pool have been sought, which has resulted in renewed interest in donation after cardio-circulatory death (DCCD), also known as non-heart beating donors (NHBDs). Objectives: To describe the derivation and implementation of a protocol for DCCD in Israel and report on the results with the first six cases. Methods: After receiving approval from an extraordinary ethics committee at the Ministry of Health, the steering committee of the National Transplant Center defined and reached consensus on the unique challenges presented by a DCCD program. These protocols included clinical aspects (construction of a clinical pathway), social and ethical aspects (presentation of the protocol at a public gathering), legal/ethical aspects (consent for organ preservation procedures being either implied if the donor had signed an organ donor card or received directly from a surrogate decision maker), and logistic aspects (pilot study confined to kidney retrieval and to four medical centers). Data regarding organ donors and recipients were recorded. Results: The protocol was implemented at four medical centers. Consent for organ donation was received from four of the six potential donors meeting criteria for inclusion and in all cases from a surrogate decision maker. Of the eight kidneys retrieved, only four were suitable for transplantation, which was carried out successfully for four recipients. Graft function remained normal in all cases at 6–12 months follow-up. Conclusions: The DCCD program was successfully implemented and initial results are encouraging, suggesting that expansion of the program might further aid in decreasing the gap between needs and availability of organs.