Sahlgrenska University Hospital supports Iceland in new donation method - first DCD performed

- Thanks to our well established cooperation with Iceland, Sahlgrenska University Hospital has been able to help throughout the introduction of DCD there, says Niclas Kvarnström, Head of Operations at the Transplant Center.

Since 2009, Sahlgrenska University Hospital has had a cooperation agreement with Iceland via Sahlgrenska International Care, which means that all Icelandic organ donations go through the hospital, while all Icelanders who need transplants are cared for here at the hospital.

- We experience only benefits from our agreement with Iceland, says transplant physician Markus Gäbel. It gives us a larger donation pool and an increased opportunity to match organs.

Through Sahlgrenska International Care and Scandiatransplant, the hospital also exchanges organs with the other Scandinavian countries and Estonia.

The terms DBD and DCD are used in donation and transplantation. DBD stands for donation after brain death, i.e. donation after primary brain damage where the heart is still beating but the patient has been declared dead. DCD stands for donation after circulatory death, i.e. donation when death has occurred after circulatory arrest in the ICU, where it was necessary to interrupt hopeless care.

DCD was introduced in Sweden in 2018. Sahlgrenska University Hospital has served as a pilot and taught the new method to a large number of other hospitals.

- At a Scandinavian transplant meeting in Reykjavik in 2022, we offered our services and a while later a delegation from Iceland came here. We helped them introduce DCD and they reviewed the legislation and anchored the new method in ICU care and healthcare in general, says Markus Gäbel.

During a week in March, a team from the Transplantation Center and the Donation Center went to Iceland to educate colleagues at the two hospitals in Reykjavik. A full day of theory with concepts developed by Sahlgrenska University Hospital was followed by two days of practical exercises with simulation of the entire chain up to the donation operation.

- We were very well received, says Pia Löwhagen Hendén, regional donation coordinator at the Regional Donation Center West and consultant at AnOpIVA Sahlgrenska. Iceland has a generally positive attitude towards organ donation. All their doctors are trained abroad, where organ donation is a natural part, and they have systems and a culture similar to ours.

A week later, it was time to perform the first DCD in Iceland. A team consisting of a surgical nurse, two surgeons, a perfusionist and two coordinators from Sahlgrenska University Hospital went there and helped perform the donation operation.

- The patient donated liver, kidneys and lungs and all organs were transported to Sahlgrenska University Hospital, says Markus Gäbel.

Once back in Sweden, the transplants took place simultaneously at Sahlgrenska Hospital and Mölndal Hospital, according to the new working method which means that kidney transplants have also been carried out at Mölndal Hospital on weekdays between 10 p.m. and 6 a.m.

- By being able to use more operating rooms at the same time, at both Sahlgrenska and Mölndal sites, we can shorten the so-called ischemia times, i.e. the time between the removal and insertion of organs, says Markus Gäbel.

The new procedure has also been very well received by the staff at Mölndal Hospital.

- It is appreciated by the surgical staff, as many of them have previously worked with similar operations, says Karin Löwhagen, consultant physician and head of operations at AnOpIVA Mölndal. It is also positive for the staff in the post-operative ward as the transplanted patients are actually comparatively healthy and feel well after the operation.

Read more (in Swedish): https://sahlgrenskaliv.se/halla-dar-karin-lowhagen/

FACTS: Cooperation with Iceland

In 2009, Sahlgrenska University Hospital signed a cooperation agreement with the Icelandic Insurance Fund on transplantation care and organ donation. The agreement means that more patients in Sweden can be transplanted while giving Icelandic patients access to the highest quality transplant care.

Over the years, the collaboration has developed and Landspitali, the largest hospital in Iceland, has referred patients to Gothenburg in more medical areas.

Sahlgrenska International Care (SIC) is a center for international cooperation that contributes to the development of care locally and globally. SIC sells specialist care and specialist training as well as providing assistance and opening up pathways to international exchanges.