To the Editor The Research Letter by Dr Bollen and colleagues1 projected the potential increase in the number of organs available for transplantation in Belgium if organ donation after euthanasia is granted to patients who voluntarily want to donate their organs after death.
I urge caution before this practice is widely accepted. First, only short-term functional outcomes immediately after transplantation and at 6 months are available.2 Second, warm ischemia, an inevitable consequence of organ donation after cardiac death, results in greater risk for transplanted organs. The study by Goldberg et al3 reported that in a liver transplant consortium within 6 months of transplantation using organs donated after cardiac death, 162 patients (21.8%) developed a biliary stricture, of which 88 patients (11.8%) exhibited intrahepatic abnormalities consistent with ischemic strictures. Graft failure by 6 months was more than 3 times higher for recipients of organs donated after cardiac death with vs without intra-hepatic strictures. However, patients receiving a pancreas transplant with an organ donated after cardiac death had patient and 1-year graft survival rates comparable with patients receiving organs donated after brain death.4 In a meta-analysis, there were no differences in 1-year mortality after lung transplantation using organs donated after cardiac death or brain death in individual studies or in the meta-analysis.5
Jindal RM. Organ Donation After Euthanasia. JAMA. 2017;318(6):576. doi:10.1001/jama.2017.8613
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