Organ procurement from non-heart-beating donors

The growing gap between organ requirements and their availability from brain-stem-dead donors has led to a re-examination of the use of non-heart-beating donors (NHBD). Many non French centers are now using such donors to expand their organ pool. In France, the relevant law was modified in 2005 in order to authorize kidney and liver donation by NHBD donors. Accordingly, the Biomedicine Agency has established a program of formal viability assessment. The protocol recommends that this practice be restricted to kidney transplantation first, before being extended to liver transplantation in a second phase. NHBD donors are defined using the Maastricht classification. Currently, the French program includes groups I, II and IV but excludes group III. Donors are patients in intractable cardiac arrest, despite intensive resuscitation, after accidents, suicide, anoxia or stroke. Organ retrieval obeys the usual legal rules : in particular, a national donation refusal registry is consulted and the relatives' formal consent is required. The results of NHBD transplantation in Europe, the USA and Japan are comparable to those obtained with brain-stem-dead donor organs. The French transplantation working group recommends that this experience be extended in order to reduce the organ shortage and the number of patients on the waiting list.