Backgrournd
It has been suggested that vascular stasis in donors after circulatory death (DCDs) leads to formation of microvascular thrombi, and that their organ viability – in particular in uncontrolled donors – may be improved through the application of fibrinolytic therapy.
We aim to study the coagulation profiles of Maastricht-2 DCDs in order to determine the presence of abnormalities that could potentially benefit from fibrinolytic therapy.

Materials and Methods
Whole blood from potential DCDs was sampled, and thromboelastometry (ROTEM®) performed. Blood was extrinsically activated (EXTEM®). Hyperfibrinolysis was defined as maximum clot lysis >15%, while fulminant fibrinolysis was defined as clot dissolution within 30min.

Results
Between August 2012 and November 2013, 30 potential DCDs were analyzed. Twenty eight (93%) were men. Mean age was 53±8 years. Mean time from arrest to death declaration was 76±16min. All patients demonstrated hyperfibrinolysis. Fibrinolysis was fulminant in 21 cases (70%). Interestingly, there was a significant inverse relationship between clot lysis at 30 min and hepatic transaminase levels (r -0.553, P=0.014). Five livers were transplanted: two from donors that demonstrated fulminant fibrinolysis, both of which developed significant postoperative complications requiring early retransplantation, and three from donors without fulminant fibrinolysis, all of which demonstrated excellent postoperative function.

Conclusion
Endogenous fibrinolysis was observed in all potential DCDs and was, in most cases, fulminant. There does not appear to be any role for additional fibrinolytic therapy in this setting. Thromboelastomeric data provides important information regarding hepatic viability and may be used as an additional tool to select DCD grafts suitable for transplantation.