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Acceptable Ischemic Times
For the purposes of transplantation following the surgical recovery of organs, it is important to be aware of the warm and cold ischemic times. These times have an impact on the long-term survivability and function of the organ in the eventual recipient.
Warm ischemic time refers to the amount of time that an organ remains at body temperature after its blood supply has been stopped or reduced. In the event of Brain Dead organ recovery, the warm ischemic time is very minimal because the time that the heart stops is virtually the same time that the organs are cooled. For a DCD organ recovery, warm ischemic time includes the amount of time that the organ is not being properly perfused prior to death, the 5 minute waiting period following death, and the time that it takes for cannulation to occur and to get the flushes and icing started. Acceptable warm ischemic times for DCD vary from transplant center to transplant center and from patient to patient.
Cold ischemic time refers to the amount of time that an organ is chilled or cold and not receiving a blood supply. Cold ischemic time varies widely by organ, but in general, the sooner an organ can be transplanted, the better. Below is a list of generally accepted cold ischemic times:
Lungs: 4-6 hours
Liver: 6-10 hours
Pancreas: 12-18 hours
Intestines: 6-12 hours
Kidneys: 24 hours (may go up to 72 hours if placed on a perfusion pump following recovery)
NORS staff will communicate with hospital staff about acceptable warm ischemic time for DCD candidates on a case-by-case basis.
Recommendations for Successful Practice
An effective and efficient DCD process including a clear role delineation and previously determined hospital staff responsible for the declaration of death in a timely manner.