Conflict of Interest Declaration
The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: none.
The following Task Force members and other authors declared an intellectual conflict of interest, and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees:
- Claudio Sandroni: none
- Tommaso Scquizzato: none
- Sonia D’Arrigo: none
- Sofia Cacciola: none
- Jasmeet Soar: none.
CoSTR Citation
Insert citation for ILCOR.org posting of CoSTR
Function and survival of solid organs transplanted from donors who underwent cardiopulmonary resuscitation (CPR) as compared to those of organs transplanted from donors who did not undergo CPR: a systematic review and meta-analysis. Claudio Sandroni, Tommaso Scquizzato, Sonia D’Arrigo, Sofia Cacciola, and Jasmeet Soar, on behalf of the ILCOR Advanced Life Support (ALS) Task Force.
Methodological Preamble and Link to Published Systematic Review
The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a systematic review (Sandroni et al., manuscript in preparation – PROSPERO registration pending). This review updates two previous reviews conducted on the same topic1, 2. In addition, the PICOST was modified by changing the outcome from patient survival to organ function, based on the latest published review2 and on discussion within the Task Force during the 2024 ILCOR Meeting in Taipei.
Systematic Review
Webmaster to insert the Systematic Review citation and link to PubMed using this format when it is available if published
PICOST
The PICOST (Population, Intervention, Comparator, Outcome, Study Designs and Timeframe)
Population: Adults and children who are receiving solid organ transplantation in any setting
Intervention: Transplantation of an organ retrieved from a donor who, following cardiac arrest, received cardiopulmonary resuscitation (e.g., donation after initial successful cardiopulmonary resuscitation or after unsuccessful cardiopulmonary resuscitation).
Comparator: Transplantation of an organ retrieved from a donor who did not receive cardiopulmonary resuscitation.
Outcomes: Primary outcome: graft function or recipient survival at the longest available follow-up. Secondary outcomes: Graft function or recipient survival at 30 days and 1 year.
Study Design: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies, case-control studies, and case series with ≥10 patients) are included. Unpublished studies, conference abstracts, trial protocols, editorials, comments, letters to the editor, and animal studies are excluded. All relevant publications in any language are included if an English abstract or full-text article is available.
Timeframe: No limits.
PROSPERO registration: CRD42024599459
Consensus on Science
A total of 35 observational studies (28 retrospective and 7 prospective) were identified. Of these, 12 reported on heart donation, 10 on kidney donation, nine on liver donation, four on pancreas donation, two on lung donation, and one on intestine donation. Twenty-three studies included adults, six included children, and six included a mix of adults and children.
The risk of bias was assessed using the ROBINS-I tool.
The outcomes of graft function or recipient survival at 30 days, 1 year, and the longest available follow-up are reported separately for each transplanted organ (heart, kidney, liver, lung, pancreas, intestine).
The outcomes were compared in brain-dead donors with prior cardiopulmonary resuscitation vs. dead donors without prior cardiopulmonary resuscitation in 28 studies, in donors from uncontrolled donation after circulatory death vs brain-dead donors without prior cardiopulmonary resuscitation in six studies, and in donors from uncontrolled donation after circulatory death vs donors from controlled donation after circulatory death without prior cardiopulmonary resuscitation in one study.
Heart
A total of 35 observational studies (28 retrospective and 7 prospective) were identified. Of these, 12 reported on heart donation, 10 on kidney donation, 9 on liver donation, 4 on pancreas donation, 2 on lung donation, and 1 on intestine donation. Twenty-three studies included adults, six included children, and six included a mix of adults and children.
Heart
For the critical outcome of graft function or recipient survival at the longest available follow-up, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 12 studies3-14 (63,805 patients; 8 enrolling 48,371 adults and 4 enrolling 15,349 children), which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 1.07 [95% CI, 0.86 to 1.33]), in adults-only studies (OR 1.25 [95% CI, 0.93 to 1.68], and in children studies (OR 0.86 [95% CI, 0.63 to 1.17]).
For the critical outcome of graft function or recipient survival at 1 year, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 9 studies3, 4, 6-10, 12, 14 (57,393 patients; 7 enrolling 47,864 adults and 2 enrolling 9,529 children), which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 1.09 [95% CI, 0.98 to 1.22]), in adults-only studies (OR 1.09 [95% CI, 0.96 to 1.23], and in children studies (OR 1.07 [95% CI, 0.97 to 1.21]).
For the critical outcome of graft function or recipient survival at 30 days, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 11 studies3-10, 12-14 (63,720 patients; 7 enrolling 48,371 adults and 2 enrolling 15,349 children), which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 1.05 [95% CI, 0.87 to 1.25]), in adults-only studies (OR 1.10 [95% CI, 0.91 to 1.31], and in children studies (OR 1.02 [95% CI, 0.69 to 1.48]).
Kidney
For the critical outcome of graft function or recipient survival at the longest available follow-up, we identified very low-certainty evidence (downgraded for inconsistency and indirectness) from 10 studies9, 15-23 (16,405 patients; 8 studies enrolling 2,794 adults and 2 studies enrolling 13,611 adults and children), which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 0.98 [95% CI, 0.73 to 1.30]), in adults-only studies (OR 0.93 [95% CI, 0.73 to 1.30], and in mixed adults and children studies (OR 1.13 [95% CI, 0.78 to 1.63]).
For the critical outcome of graft function or recipient survival at 1 year, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 6 studies3, 4, 6-10, 12, 14 (15,494 patients; 4 studies enrolling 1,883 adults and 2 studies enrolling 13,611 adults and children), which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 0.86 [95% CI, 0.62 to 1.18]) and in mixed adults and children studies (OR, 1.13 [95% CI, 0.78 to 1.62]), and worse graft or recipient survival in adults-only studies (OR, 0.70 [95% CI, 0.53 to 0.92]). However, this was observed only when the comparison was made between uDCDs vs. DBDs, while it was not observed when the comparison was made between uDCDs vs. cDCDs or DBDs after CPR vs. DBDs without CPR.
For the critical outcome of graft function or recipient survival at 30 days, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 7 studies16-20, 22, 23 (2,686 adult patients). These studies showed worse graft or recipient survival in organ recipients from donors who received CPR versus donors who did not (OR, 0.22 [95% CI, 0.08 to 0.65]). However, this was observed only when the comparison was made between uDCDs vs. DBDs, while it was not observed when it was made between uDCDs vs. cDCDs or DBDs after CPR vs. DBDs without CPR.
Liver
For the critical outcome of graft function or recipient survival at the longest available follow-up, we identified very low certainty of evidence (downgraded for inconsistency and indirectness from 9 studies15, 24-31 (6,714 patients; 5 enrolling 5954 adults, 2 enrolling 510 adults and children, and 1 enrolling 240 children), which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received cardiopulmonary resuscitation versus donors who did not receive cardiopulmonary resuscitation in all studies (OR, 0.90 [95% CI, 0.70 to 1.16]), in adults-only studies (OR 0.82 [95% CI, 0.55 to 1.21], in mixed adults and children studies (OR 1.15 [95% CI, 0.30 to 4.43]), and in children studies (OR 0.95 [95% CI, 0.36 to 2.47]).
However, in the subgroup analysis, we observed a worse outcome when comparing uDCDs to DBDs, while this was not observed when comparing DBDs after CPR to DBDs without CPR.
For the critical outcome of graft function or recipient survival at 1 year, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 3 studies15, 25, 26 in 839 adult patients, showing no statistically significant difference in graft or recipient survival in organ recipients from donors who received cardiopulmonary resuscitation versus donors who did not (OR, 0.52 [95% CI, 0.25 to 1.07]). However, in the subgroup analysis, we observed a worse outcome when the comparison was made between uDCDs vs. DBDs, while this was not observed when the comparison was made between DBDs after CPR vs. DBDs without CPR.
For the critical outcome of graft function or recipient survival at 30 days, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 8 studies24-31 (6674 patients; 5 enrolling 5954 adults, 2 enrolling 510 adults and children, and one enrolling 210 children), which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received cardiopulmonary resuscitation versus donors who did not receive cardiopulmonary resuscitation in all studies (OR 0.79 [95% CI, 0.42 to 1.46]), in adults-only studies (OR 0.45 [95% CI, 0.18 to 1.14]), and in mixed adults and children studies (OR 1.15 [95% CI, 0.30 to 4.43]), and better in 1 pediatric study (OR 2.23 [95% CI, 1.07 to 4.67]).
Lung
For the critical outcome of graft function or recipient survival at the longest available follow-up, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 2 studies enrolling 1,194 adult patients, which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 1.82 [95% CI, 0.37 to 9.11]). We found no studies reporting this outcome in children.
We found no studies reporting the critical outcome of graft function or recipient survival at 1 year,
For the critical outcome of graft function or recipient survival at 30 days, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 2 studies enrolling 1,150 adult patients, which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 0.74 [95% CI, 0.48 to 1.12]). We found no studies reporting this outcome in children.
Pancreas
For the critical outcome of graft function or recipient survival at the longest available follow-up, we identified very low certainty of evidence (downgraded for indirectness) from 4 studies (14,559 patients; 2 enrolled 948 adults and 2 enrolled 13,611 adults and children). The studies showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 1.04 [95% CI, 0.87 to 1.25]), in adults-only studies (OR 1.03 [95% CI, 0.62 to 1.72], and in mixed adults and children studies (OR 1.04 [95% CI, 0.86 to 1.27]). We found no studies reporting this outcome in children.
For the critical outcome of graft function or recipient survival at 1 year, we identified very low certainty of evidence (downgraded for indirectness) from one study enrolling 13,095 adults and children, which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 1.01 [95% CI, 0.81 to 1.25]). We found no studies reporting this outcome in adults only or in children.
For the critical outcome of graft function or recipient survival at 30 days, we identified very low certainty of evidence (downgraded for indirectness) from 1 study enrolling 606 adults, which showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received CPR versus donors who did not receive CPR in all studies (OR, 0.60 [95% CI, 0.24 to 1.50]). We found no studies reporting this outcome in children.
Intestine
For the critical outcome of graft function or recipient survival at the longest follow-up available, we identified very low certainty of evidence (downgraded for inconsistency and indirectness) from 1 study32 enrolling 67 adults. The study showed no statistically significant difference in graft or recipient survival in organ recipients from donors who received cardiopulmonary resuscitation versus those who did not in all studies (OR, 1.11 [95% CI, 0.21 to 5.88]).
We found no studies reporting this outcome for the critical outcome of graft function or recipient survival at 1 year or for the critical outcome of graft function or recipient survival at 30 days.
The certainty of the evidence was very low because:
- All studies were observational
- We found inconsistencies in the timing of the longest follow-up (from 7 days to 15 years) and the variables considered for adjustment.
- There was indirectness:
- in most studies on organs retrieved from DBD donors, the timing of cardiac arrest and CPR was unclear (i.e., before vs. after death by neurological criteria), so we cannot exclude that in some patients, cardiac arrest and resuscitation may have followed, rather than preceded, death by neurological criteria (cardiac arrest in a brain-dead donor, Maastricht category IV).
- in some studies on organs retrieved from uDCD donors, the witnessed status of the original cardiac arrest was not specified. Therefore, we cannot exclude that in some patients, CPR was performed on a patient who would not be otherwise resuscitated (found dead and resuscitated solely for organ donation; Maastricht I donor).
Treatment Recommendations
We recommend that all patients who have restoration of circulation after cardiopulmonary resuscitation and who subsequently progress to death be evaluated for organ donation (strong recommendation, low-certainty evidence).
Justification and Evidence to Decision Framework Highlights
The major concern with organ donation from patients who have undergone CPR is damage to their organs from ischemia and reperfusion injury. However, the suitability of organs for donation is based on criteria established by the transplantation team. This review suggests that, once these criteria are met, transplant organ outcomes are similar regardless of whether the organs come from donors who have had CPR or not before donation.
We have used the term ‘restoration of circulation’ to include patients who become potential organ donors after ECPR and are stabilized on VA-ECMO but do not have spontaneous circulation.
Despite the low-certainty evidence, the TF has made a strong recommendation. This is because the TF values ensuring that those waiting for a donated organ can benefit from organs donated by those who die after CPR, given that a large number of studies show organ function and recipient outcomes are similar in CPR+ and CPR- groups.
Seven of the 35 studies in this review compared the outcomes of kidneys and livers transplanted from patients who died after unsuccessful resuscitation (uncontrolled donors after cardiac death [uDCDs]; Maastricht category II) with those of organs transplanted from donors after death by neurological criteria (donors after brain death [DBDs]; six studies16, 17, 19, 23, 25, 26) or from donors who die by cardiac criteria after life-sustaining treatment is suspended because of futility (controlled donors after cardiac death [cDCDs]: Maastricht category III; one study).22 In these studies, the outcomes of organs transplanted from uDCDs at one month and one year were significantly worse than in the comparator group.
In uDCD studies, the donors’ witnessed status was not always explicitly reported. Consequently, there was a chance that some donors were unrecoverable at the arrival of the treating team (found dead) and that resuscitation was started only with the aim of potential donation (Maastricht category I). Because of this inconsistency, the Task Force decided not to make any recommendation regarding uncontrolled organ donors.
Knowledge Gaps
- Future studies on DBDs who underwent CPR should clearly identify those who evolved towards death by neurological criteria after resuscitation to avoid confusion with DBDs who had cardiac arrest before organ retrieval.
- Comparative studies are needed to investigate cDCD donation after CPR
- Future studies should investigate the utilization rate of donors who underwent CPR vs those who did not.
- There are no established criteria to identify the potential for donation in patients who die after CPR.
EtD Summary Table: ALS 3600 Organ Donation ETD
Grade Table: ALS 3600 GRADE Organ Donation Table
References
1. Sandroni C, Adrie C, Cavallaro F, Marano C, Monchi M, Sanna T and Antonelli M. Are patients brain-dead after successful resuscitation from cardiac arrest suitable as organ donors? A systematic review. Resuscitation. 2010;81:1609-14.
2. West S, Soar J and Callaway CW. The viability of transplanting organs from donors who underwent cardiopulmonary resuscitation: A systematic review. Resuscitation. 2016;108:27-33.
3. Ali AA, Lim E, Thanikachalam M, Sudarshan C, White P, Parameshwar J, Dhital K and Large SR. Cardiac arrest in the organ donor does not negatively influence recipient survival after heart transplantation. Eur J Cardiothorac Surg. 2007;31:929-33.
4. Cheng A, Schumer EM, Trivedi JR, Van Berkel VH, Massey HT and Slaughter MS. Does Donor Cardiopulmonary Resuscitation Time Affect Heart Transplantation Outcomes and Survival? Ann Thorac Surg. 2016;102:751-758.
5. de Begona JA, Gundry SR, Razzouk AJ, Boucek MM, Kawauchi M and Bailey LL. Transplantation of hearts after arrest and resuscitation. Early and long-term results. J Thorac Cardiovasc Surg. 1993;106:1196-201; discussion 1200-1.
6. Galeone A, Varnous S, Lebreton G, Barreda E, Hariri S, Pavie A and Leprince P. Impact of cardiac arrest resuscitated donors on heart transplant recipients' outcome. J Thorac Cardiovasc Surg. 2017;153:622-630.
7. L'Ecuyer T, Sloan K and Tang L. Impact of donor cardiopulmonary resuscitation on pediatric heart transplant outcome. Pediatr Transplant. 2011;15:742-5.
8. Mehdiani A, Immohr MB, Sipahi NF, Boettger C, Dalyanoglu H, Scheiber D, Westenfeld R, Aubin H, Lichtenberg A, Boeken U and Akhyari P. Successful Heart Transplantation after Cardiopulmonary Resuscitation of Donors. Thorac Cardiovasc Surg. 2021;69:504-510.
9. Messner F, Etra JW, Yu Y, Massie AB, Jackson KR, Brandacher G, Schneeberger S, Margreiter C and Segev DL. Outcomes of simultaneous pancreas and kidney transplantation based on donor resuscitation. Am J Transplant. 2020;20:1720-1728.
10. Quader MA, Wolfe LG and Kasirajan V. Heart transplantation outcomes from cardiac arrest-resuscitated donors. J Heart Lung Transplant. 2013;32:1090-5.
11. Roth S, M'Pembele R, Nucaro A, Stroda A, Tenge T, Lurati Buse G, Sixt SU, Westenfeld R, Rellecke P, Tudorache I, Hollmann MW, Aubin H, Akhyari P, Lichtenberg A, Huhn R and Boeken U. Impact of Cardiopulmonary Resuscitation of Donors on Days Alive and Out of Hospital after Orthotopic Heart Transplantation. J Clin Med. 2022;11.
12. Sainathan S, Said S, Tsujimoto T, Lin FC, Mullinari L and Sharma M. Impact of occurrence of cardiac arrest in the donor on long-term outcomes of pediatric heart transplantation. J Card Surg. 2022;37:4875-4882.
13. Sánchez-Lázaro IJ, Almenar-Bonet L, Martínez-Dolz L, Buendía-Fuentes F, Agüero J, Navarro-Manchón J, Raso-Raso R and Salvador-Sanz A. Can we accept donors who have suffered a resuscitated cardiac arrest? Transplant Proc. 2010;42:3091-2.
14. Yang Y, Gyoten T, Amiya E, Ito G, Kaobhuthai W, Ando M, Shimada S, Yamauchi H and Ono M. Impact of prolonged cardiopulmonary resuscitation on outcomes in heart transplantation with higher risk donor heart. Gen Thorac Cardiovasc Surg. 2024;72:455-465.
15. Adrie C, Haouache H, Saleh M, Memain N, Laurent I, Thuong M, Darques L, Guerrini P and Monchi M. An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest. Intensive Care Med. 2008;34:132-7.
16. Bains JC, Sandford RM, Brook NR, Hosgood SA, Lewis GR and Nicholson ML. Comparison of renal allograft fibrosis after transplantation from heart-beating and non-heart-beating donors. Br J Surg. 2005;92:113-8.
17. Barlow AD, Metcalfe MS, Johari Y, Elwell R, Veitch PS and Nicholson ML. Case-matched comparison of long-term results of non-heart beating and heart-beating donor renal transplants. Br J Surg. 2009;96:685-91.
18. Buggs J, Rogers E and Bowers V. The Impact of CPR in High-Risk Donation after Circulatory Death Donors and Extended Criteria Donors for Kidney Transplantation. Am Surg. 2018;84:1164-1168.
19. Campi R, Pecoraro A, Sessa F, Vignolini G, Caroti L, Lazzeri C, Peris A, Serni S, Li Marzi V and University of Florence Kidney Transplantation Working G. Outcomes of kidney transplantation from uncontrolled donors after circulatory death vs. expanded-criteria or standard-criteria donors after brain death at an Italian Academic Center: a prospective observational study. Minerva Urol Nephrol. 2023;75:329-342.
20. Echterdiek F, Kitterer D, Dippon J, Paul G, Schwenger V and Latus J. Impact of cardiopulmonary resuscitation on outcome of kidney transplantations from braindead donors aged >/=65 years. Clin Transplant. 2021;35:e14452.
21. Hinzmann J, Grzella S, Lengenfeld T, Pillokeit N, Hummels M, Vaihinger HM, Westhoff TH, Viebahn R and Schenker P. Impact of donor cardiopulmonary resuscitation on the outcome of simultaneous pancreas-kidney transplantation-a retrospective study. Transpl Int. 2020;33:644-656.
22. Hoogland ER, Snoeijs MG, Winkens B, Christaans MH and van Heurn LW. Kidney transplantation from donors after cardiac death: uncontrolled versus controlled donation. Am J Transplant. 2011;11:1427-34.
23. Sanchez-Fructuoso AI, Perez-Flores I, Del Rio F, Blazquez J, Calvo N, Moreno de la Higuera MA, Gomez A, Alonso-Lera S, Soria A, Gonzalez M, Corral E, Mateos A, Moreno-Sierra J and Fernandez Perez C. Uncontrolled donation after circulatory death: A cohort study of data from a long-standing deceased-donor kidney transplantation program. Am J Transplant. 2019;19:1693-1707.
24. Hoyer DP, Paul A, Saner F, Gallinat A, Mathe Z, Treckmann JW, Schulze M, Kaiser GM, Canbay A, Molmenti E and Sotiropoulos GC. Safely expanding the donor pool: brain dead donors with history of temporary cardiac arrest. Liver Int. 2015;35:1756-63.
25. Jimenez-Galanes S, Meneu-Diaz MJ, Elola-Olaso AM, Perez-Saborido B, Yiliam FS, Calvo AG, Usera MA, Gonzalez MC, Gonzalez JC and Gonzalez EM. Liver transplantation using uncontrolled non-heart-beating donors under normothermic extracorporeal membrane oxygenation. Liver Transpl. 2009;15:1110-8.
26. Justo I, Marcacuzco A, Garcia-Conde M, Caso O, Cobo C, Nutu A, Manrique A, Calvo J, Garcia-Sesma A, Rivas C, Loinaz C and Jimenez-Romero C. Liver Transplantation in Sexagenarian Patients Using Grafts From Uncontrolled Circulatory Death Versus Grafts From Brain Death Donation. Transplant Proc. 2022;54:1839-1846.
27. Levesque E, Hoti E, Khalfallah M, Salloum C, Ricca L, Vibert E and Azoulay D. Impact of reversible cardiac arrest in the brain-dead organ donor on the outcome of adult liver transplantation. Liver Transpl. 2011;17:1159-66.
28. Mangus RS, Schroering JR, Fridell JA and Kubal CA. Impact of Donor Pre-Procurement Cardiac Arrest (PPCA) on Clinical Outcomes in Liver Transplantation. Ann Transplant. 2018;23:808-814.
29. Schroering JR, Hathaway TJ, Kubal CA, Ekser B, Mihaylov P and Mangus RS. Impact of donor preprocurement cardiac arrest on clinical outcomes in pediatric deceased donor liver transplantation. Pediatr Transplant. 2020;24:e13701.
30. Totsuka E, Fung JJ, Urakami A, Moras N, Ishii T, Takahashi K, Narumi S, Hakamada K and Sasaki M. Influence of donor cardiopulmonary arrest in human liver transplantation: possible role of ischemic preconditioning. Hepatology. 2000;31:577-80.
31. Wilson DJ, Fisher A, Das K, Goerlitz F, Holland BK, De La Torre AN, Merchant A, Seguel J, Samanta AK and Koneru B. Donors with cardiac arrest: improved organ recovery but no preconditioning benefit in liver allografts. Transplantation. 2003;75:1683-7.
32. Matsumoto CS, Kaufman SS, Girlanda R, Little CM, Rekhtman Y, Raofi V, Laurin JM, Shetty K, Fennelly EM, Johnson LB and Fishbein TM. Utilization of donors who have suffered cardiopulmonary arrest and resuscitation in intestinal transplantation. Transplantation. 2008;86:941-6.