Is Donation after Circulatory Determination of Death in Japan Uncontrolled or Controlled?

Abstract

Using donation after circulatory determination of death (DCD) donors has been shown to be a potential means of increasing the number of donors for organ transplantation. The purpose of this study was to examine the published practice of DCD in Japan to properly define their practice as controlled or uncontrolled. Through the Web of Science database, we systematically searched articles describing uncontrolled DCD, controlled DCD or Maastricht classification. A total of 12 articles (ten articles related to kidney, one to pancreas, another to islet transplantation), which were published between 1999 and 2023 from Japanese institutes, were eligible for our study. Systematic review revealed that most DCD in Japan occurs when a terminally ill patient undergoes an expected cardiac arrest without rapid discontinuation from a ventilator, and in some cases with premortem interventions such as cannulation to the femoral vessels. Surprisingly, these DCD donors in Japan have been categorized as uncontrolled DCD. This categorization confuses the donation and transplantation community globally because the international consensus is that uncontrolled DCD occurs after an unexpected cardiac arrest. Further clear definition of terminology would be required within Japan as well as other countries practicing uncontrolled DCD.