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Original article

Vol. 152 No. 0708 (2022)

Organ donation after circulatory death as compared with organ donation after brain death in Switzerland – an observational study

  • Andreas Elmer
  • Mara-Lisa Rohrer
  • Christian Benden
  • Nathalie Krügel
  • Franziska Beyeler
  • Franz F Immer
Cite this as:
Swiss Med Wkly. 2022;152:w30132


AIMS OF THE STUDY: Organ donation after circulatory death (DCD) was reintroduced in Switzerland in 2011 and accounts for a third of deceased organ donors today. Controversy persists if DCD transplants are of similar quality to transplants following donation after brain death (DBD), mainly due to warm ischaemia time DCD organs are exposed to. We compared DCD with DBD in Switzerland.

METHODS: Data on deceased adults who were referred to and approved for organ donation from 1 September 2011 to 31 December 2019 were retrospectively analysed (217 DCD, 840 DBD donors). We compared DCD and DBD donor/organ characteristics, transplant rates of lungs, liver, kidneys, and pancreas, and early liver and kidney graft function in the recipient. The effect of DCD/DBD on transplant rates (organ transplanted or not) and 72-hour recipient graft function (moderate/good vs delayed graft function / organ loss) was analysed using multivariable logistic regression. Among utilised DCD donors, we analysed the effect of functional warm ischaemia time (FWIT) and donor age on 72-hour post-transplant liver and kidney graft function, also using multivariable logistic regression.

RESULTS: DCD donors were more often male (64.5% vs 56.8% p = 0.039), presented with heart disease (36.4% vs 25.5%, p <0.001), were resuscitated before hospital admission (41.9% vs 30.7%, p = 0.006), and died from anoxia (41.9% vs 23.9%). Kidney function before transplantation was comparable, lung, liver and pancreas function were poorer in DCD than DBD. Eighty-one and 91% of approved DCD and DBD donors were utilised (p <0.001). Median FWIT in DCD was 29 minutes (interquartile range 25–35). DCD transplant rates ranged from 4% (pancreas) to 73% (left kidney) and were all lower compared with DBD. Seventy-two-hour liver graft function was comparable between DCD and DBD (94.2% vs 96.6% moderate/good, p = 0.199). DCD kidney transplants showed increased risk of delayed graft function or early organ loss (odds ratios 8.32 and 5.05; 95% confidence intervals CI 5.28–13.28 and 3.22–7.95; both p <0.001, for left and right kidney transplants, respectively). No negative effect of prolonged FWIT or higher donor age was detected.

CONCLUSION: Despite less favourable donor/organ characteristics compared with donation after brain death, donation after circulatory death donors are increasingly referred and today provide an important source for scarce transplants in Switzerland. We identified a higher risk for delayed graft function or early organ loss for DCD kidney transplants, but not for DCD liver transplants. When carefully selected and allowed for other risk factors in organ allocation, prolonged functional warm ischaemia time or higher age in donation after circulatory death does not seem to be associated with impaired graft function early after transplantation.


  1. Bleisch B, Schuurmans MM, Klaghofer R, Benden C, Seiler A, Jenewein J. Health-related quality of life and stress-related post-transplant trajectories of lung transplant recipients: a three-year follow-up of the Swiss Transplant Cohort Study. Swiss Med Wkly. 2019 Feb;149(07-08).
  2. Mazzoni D, Cicognani E, Mosconi G, Totti V, Roi GS, Trerotola M, et al. Sport activity and health-related quality of life after kidney transplantation. Transplant Proc. 2014 Sep;46(7):2231–4.
  3. Casanovas T, Herdman M, Chandía A, Peña MC, Fabregat J, Vilallonga JS. Identifying Improved and Non-improved Aspects of Health-related Quality of Life After Liver Transplantation Based on the Assessment of the Specific Questionnaire Liver Disease Quality of Life. Transplant Proc. 2016 Jan-Feb;48(1):132–7.
  4. Singer LG, Chowdhury NA, Faughnan ME, Granton J, Keshavjee S, Marras TK, et al. Effects of Recipient Age and Diagnosis on Health-related Quality-of-Life Benefit of Lung Transplantation. Am J Respir Crit Care Med. 2015 Oct;192(8):965–73.
  5. Duffy JP, Kao K, Ko CY, Farmer DG, McDiarmid SV, Hong JC, et al. Long-Term Patient Out-come and Quality of Life After Liver Transplantation: Analysis of 20-Year Survivors. Trans Meet Am Surg Assoc Am Surg Assoc. 2010;128:264–74.
  6. Kugler C, Gottlieb J, Warnecke G, Schwarz A, Weissenborn K, Barg-Hock H, et al. Health-related quality of life after solid organ transplantation: a prospective, multiorgan cohort study. Transplantation. 2013 Aug;96(3):316–23.
  7. Kostro JZ, Hellmann A, Kobiela J, Skóra I, Lichodziejewska-Niemierko M, Dębska-Ślizień A, et al. Quality of Life After Kidney Transplantation: A Prospective Study. Transplant Proc. 2016 Jan-Feb;48(1):50–4.
  8. van Adrichem EJ, Siebelink MJ, Rottier BL, Dilling JM, Kuiken G, van der Schans CP, et al. Tol-erance of Organ Transplant Recipients to Physical Activity during a High-Altitude Expedition: Climbing Mount Kilimanjaro. Eller K, editor. PLOS ONE. 2015 Nov 25;10(11):e0142641.
  9. De Baere C, Delva D, Kloeck A, Remans K, Vanrenterghem Y, Verleden G, et al. Return to work and social participation: does type of organ transplantation matter? Transplantation. 2010 Apr;89(8):1009–15.
  10. Cavallini J, Forsberg A, Lennerling A. Social function after solid organ transplantation: an integra-tive review. Nord J Nurs Res. 2015 Dec;35(4):227–34.
  11. EDQM. Guide to the quality and safety of organs for transplantation [Internet]. European Direc-torate for the Quality of Medicines & HealthCare of the Council of Europe (EDQM); 2018. Available from:
  12. Lomero M, Gardiner D, Coll E, Haase-Kromwijk B, Procaccio F, Immer F, et al.; European Committee on Organ Transplantation of the Council of Europe (CD-P-TO). Donation after circulatory death today: an updated overview of the European landscape. Transpl Int. 2020 Jan;33(1):76–88.
  13. The World Health Organization (WHO), The Spanish Transplant Organization, Organización Nacional de Trasplantes (ONT). Global Observatory on Donation and Transplantation (GODT [Internet]. Number of Actual donors after circulatory death (DCD). 2019 [cited 2021 Aug 30]. Available from:
  14. The Federal Assembly of the Swiss Confederation. Federal Act on the Transplantation of Organs, Tissues and Cells [Internet]. 810.21 Oct 8, 2004. Available from:
  15. Der Schweizerische Bundesrat. Verordnung über die Transplantation von menschlichen Organen, Geweben und Zellen [Internet]. 810.211 Mar 16, 2007. Available from:
  16. Wälchli-Bhend S, Beyeler F, Weiss J, Immer FF. How an Existing Donation After Circulatory Death Program Was Grounded and Re-Started in Switzerland. Organs. Tissue Cell. 2011;14:25–6.
  17. Weber M, Dindo D, Demartines N, Ambühl PM, Clavien PA. Kidney transplantation from donors without a heartbeat. N Engl J Med. 2002 Jul;347(4):248–55.
  18. Swiss Academyof Medical Sciences (SAMS). Determination of Death with Regard to Organ Transplantation and Preparations for Organ Removal [Internet]. 2017 p. 34. Available from:
  19. Immer FF. Organ donation after circulatory death in Switzerland: slow but constant progress. Swiss Med Wkly. 2015 Jan;145:w14062.
  20. Swisstransplant. Jahresbericht 2020 [2020 annual report] [Internet]. 2021 [cited 2021 Aug 13]. Available from:
  21. Council of Europe. International figures on donation and transplantation 2020. 2021. (Newsletter Transplant). Report No.: 26.
  22. Weiss J, Elmer A, Béchir M, Brunner C, Eckert P, Endermann S, et al.; Comité National du Don d’Organes (CNDO). Deceased organ donation activity and efficiency in Switzerland between 2008 and 2017: achievements and future challenges. BMC Health Serv Res. 2018 Nov;18(1):876.
  23. Smith M, Dominguez-Gil B, Greer DM, Manara AR, Souter MJ. Organ donation after circulatory death: current status and future potential. Intensive Care Medicine [Internet]. 2019 Feb 6 [cited 2019 Mar 21]; Available from:
  24. Rijkse E, Ceuppens S, Qi H, IJzermans JN, Hesselink DA, Minnee RC. Implementation of donation after circulatory death kidney transplantation can safely enlarge the donor pool: A systematic review and meta-analysis. Int J Surg. 2021 Aug;92:106021.
  25. Gavriilidis P, Inston NG. Recipient and allograft survival following donation after circulatory death versus donation after brain death for renal transplantation: A systematic review and meta-analysis. Transplant Rev (Orlando). 2020 Oct;34(4):100563.
  26. de Kok MJ, Schaapherder AF, Alwayn IP, Bemelman FJ, van de Wetering J, van Zuilen AD, et al. Improving outcomes for donation after circulatory death kidney transplantation: Science of the times. Dor FJ, editor. PLoS ONE. 2020 Jul 29;15(7):e0236662.
  27. Summers DM, Watson CJ, Pettigrew GJ, Johnson RJ, Collett D, Neuberger JM, et al. Kidney donation after circulatory death (DCD): state of the art. Kidney Int. 2015 Aug;88(2):241–9.
  28. Summers DM, Johnson RJ, Allen J, Fuggle SV, Collett D, Watson CJ, et al. Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study. Lancet. 2010 Oct;376(9749):1303–11.
  29. Kumar S, Lin S, Schold JD. Impact of donation after circulatory death donor allografts on outcomes following liver transplantation for fulminant hepatic failure in the United States. Am J Transplant. 2021 Jan;21(1):382–90.
  30. Silverstein J, Roll G, Dodge JL, Grab JD, Yao FY, Mehta N. Donation After Circulatory Death Is Associated With Similar Posttransplant Survival in All but the Highest-Risk Hepatocellular Carcinoma Patients. Liver Transpl. 2020 Sep;26(9):1100–11.
  31. Laing RW, Scalera I, Isaac J, Mergental H, Mirza DF, Hodson J, et al. Liver Transplantation Using Grafts From Donors After Circulatory Death: A Propensity Score-Matched Study From a Single Center. Am J Transplant. 2016 Jun;16(6):1795–804.
  32. Blok JJ, Detry O, Putter H, Rogiers X, Porte RJ, van Hoek B, et al.; Eurotransplant Liver Intestine Advisory Committee. Longterm results of liver transplantation from donation after circulatory death. Liver Transpl. 2016 Aug;22(8):1107–14.
  33. Zhou J, Chen B, Liao H, Wang Z, Lyu M, Man S, et al. The Comparable Efficacy of Lung Donation After Circulatory Death and Brain Death: A Systematic Review and Meta-analysis. Transplantation. 2019 Dec;103(12):2624–33.
  34. Van Raemdonck D, Keshavjee S, Levvey B, Cherikh WS, Snell G, Erasmus M, et al.; International Society for Heart and Lung Transplantation. Donation after circulatory death in lung transplantation-five-year follow-up from ISHLT Registry. J Heart Lung Transplant. 2019 Dec;38(12):1235–45.
  35. Krutsinger D, Reed RM, Blevins A, Puri V, De Oliveira NC, Zych B, et al. Lung transplantation from donation after cardiocirculatory death: a systematic review and meta-analysis. J Heart Lung Transplant. 2015 May;34(5):675–84.
  36. Shahrestani S, Webster AC, Lam VW, Yuen L, Ryan B, Pleass HC, et al. Outcomes From Pancreatic Transplantation in Donation After Cardiac Death: A Systematic Review and Meta-Analysis. Transplantation. 2017 Jan;101(1):122–30.
  37. van Loo ES, Krikke C, Hofker HS, Berger SP, Leuvenink HG, Pol RA. Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death. Pancreatology. 2017 Jan - Feb;17(1):13–8.
  38. Thuong M, Ruiz A, Evrard P, Kuiper M, Boffa C, Akhtar MZ, et al. New classification of donation after circulatory death donors definitions and terminology. Transpl Int. 2016 Jul;29(7):749–59.
  39. Comité National du Don d’Organes (CNDO), Swisstransplant. Swiss Donation Pathway [Internet]. 2020 [cited 2021 Aug 3]. Available from:
  40. Roeb E, Steffen HM, Bantel H, Baumann U, Canbay A, Demir M, et al. S2k-Leitlinie nicht alkoholische Fettlebererkrankungen. Z Gastroenterol. 2015 Jul;53(7):668–723.
  41. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al.; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009 May;150(9):604–12.
  42. R Core Team. R: A language and environment for statistical computing. [Internet]. Vienna, Aus-tria: R Foundation for Statistical Computing; 2017. Available from:
  43. Gottschalk M, Elmer A, Benden C, Beyeler F, Immer F. Impact of cardiopulmonary resuscitation on organ donation in Switzerland. Swiss Med Wkly [Internet]. 2021 Feb 5 [cited 2021 Feb 19]; Available from:
  44. Reid AW, Harper S, Jackson CH, Wells AC, Summers DM, Gjorgjimajkoska O, et al. Expansion of the Kidney Donor Pool by Using Cardiac Death Donors with Prolonged Time to Cardiorespiratory Ar-rest: Expanding Pool Using DCD with Prolonged Agonal Phase. Am J Transplant. 2011 May;11(5):995–1005.
  45. Leiden H, Haase-Kromwijk B, Hoitsma A, Jansen N. Controlled donation after circulatory death in the Netherlands: more organs, more efforts. Neth J Med. 2016 Aug;74(7):285–91.
  46. Lewis J, Peltier J, Nelson H, Snyder W, Schneider K, Steinberger D, et al. Development of the University of Wisconsin donation After Cardiac Death Evaluation Tool. Prog Transplant. 2003 Dec;13(4):265–73.
  47. DeVita MA, Brooks MM, Zawistowski C, Rudich S, Daly B, Chaitin E. Donors after cardiac death: validation of identification criteria (DVIC) study for predictors of rapid death. Am J Transplant. 2008 Feb;8(2):432–41.
  48. Wind J, Snoeijs MG, Brugman CA, Vervelde J, Zwaveling J, van Mook WN, et al. Prediction of time of death after withdrawal of life-sustaining treatment in potential donors after cardiac death. Crit Care Med. 2012 Mar;40(3):766–9.
  49. Nijhoff MF, Pol RA, Volbeda M, Kotsopoulos AM, Sonneveld JP, Otterspoor L, et al. External Validation of the DCD-N Score and a Linear Prediction Model to Identify Potential Candidates for Organ Donation After Circulatory Death: A Nationwide Multicenter Cohort Study. Transplantation. 2021 Jun;105(6):1311–6.
  50. Kotsopoulos AM, Böing-Messing F, Jansen NE, Vos P, Abdo WF. External validation of prediction models for time to death in potential donors after circulatory death. Am J Transplant. 2018 Apr;18(4):890–6.
  51. Scheuer SE, Jansz PC, Macdonald PS. Heart transplantation following donation after circulatory death: expanding the donor pool. J Heart Lung Transplant. 2021 Sep;40(9):882–9.
  52. NHS Blood and Transplant. Contribution of DCD to transplantation in the UK [Internet]. Donation after circulatory death. Available from:
  53. Sandroni C, Dell’anna AM, Tujjar O, Geri G, Cariou A, Taccone FS. Acute kidney injury after cardiac arrest: a systematic review and meta-analysis of clinical studies. Minerva Anestesiol. 2016 Sep;82(9):989–99.
  54. Roedl K, Jarczak D, Blohm R, Winterland S, Müller J, Fuhrmann V, et al. Epidemiology of intensive care unit cardiac arrest: Characteristics, comorbidities, and post-cardiac arrest organ failure - A prospective observational study. Resuscitation. 2020 Nov;156:92–8.
  55. De Beule J, Vandendriessche K, Pengel LHM, Bellini MI, Dark JH, Hessheimer AJ, et al. A sys-tematic review and meta‐analyses of regional perfusion in donation after circulatory death solid organ transplantation. Transpl Int. 2021 Sep 27;tri.14121.
  56. Nelson HM, Glazier AK, Delmonico FL. Changing Patterns of Organ Donation: Brain Dead Do-nors Are Not Being Lost by Donation After Circulatory Death. Transplantation. 2015;(Oct):1.
  57. Suntharalingam C, Sharples L, Dudley C, Bradley JA, Watson CJ. Time to cardiac death after withdrawal of life-sustaining treatment in potential organ donors. Am J Transplant. 2009 Sep;9(9):2157–65.
  58. Blok JJ, Ringers J, Schaapherder AF, Dubbeld J, Baranski AG, de Fijter JW, et al. Report of the first five DCDD pancreas transplants within the Eurotransplant region; excellent results with prolonged first warm ischemia times. Transpl Int. 2013 Apr;26(4):e31–3.
  59. Taner CB, Bulatao IG, Perry DK, Sibulesky L, Willingham DL, Kramer DJ, et al. Asystole to cross-clamp period predicts development of biliary complications in liver transplantation using donation after cardiac death donors. Transpl Int. 2012 Aug;25(8):838–46.

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