Complications associated with a donor who had a cardiac death:
(1) early graft failure
(2) ischemic cholangiopathy with or without biliary strictures
(3) anastomotic biliary stricture
(4) renal insufficiency with need for dialysis
(5) thrombosis or stricture of the hepatic artery
One issue affecting the quality of the graft is the donor-related warm ischemia time (WIT) which involves:
(1) a 5-minute waiting period after asystole before donor incision
(2) time from donor incision to graft flushing
(3) antemortem vital measures prior to asystole (systolic blood pressure < 50 mm Hg; oxygen saturation < 70%)
The risk for complications can be reduced by:
(1) careful selection of donors (donor age < 45 years, donor WIT <= 20 minutes)
(2) optimal graft harvesting and handling
(3) renal-sparing immunosuppressive regimen