Background: To increase the number of deceased organ donors in Sweden, a national initiative to implement controlled donation after circulatory death (cDCD) was launched in 2016. Drawing on international experience and supported by the Swedish Tissue Council and the Swedish Association of Local Authorities and Regions, the project aimed to safely, ethically, and sustainably integrate DCD into national clinical practice.
Methods: A multidisciplinary team conducted a national ICU inventory, health economic analysis, and study visits to established international programs. A standardized pilot protocol was developed, including withdrawal of life-sustaining treatment in ICU, no premortal interventions, a five-minute no-touch period, followed by cold perfusion and rapid recovery in the OR. The initial pilot, launched in six hospitals in 2018, focused on kidney and lung transplantation.
Results: By the end of the pilot in 2019, 10 donors enabled 17 kidney and 1 lung transplant, with favorable outcomes. National implementation followed, supported by structured education and standardized protocols. As of early 2024, more than 400 kidney and over 30 lung transplants have been performed using DCD donors.
Liver transplantation with DCD donors was introduced after the initial pilot, through a national protocol requiring abdominal normothermic regional perfusion (A-NRP). Over 90 liver transplants have since been performed with excellent outcomes.
To date, over 220 DCD donors have contributed to organ transplantation in Sweden. In 2023, DCD accounted for 26% of all deceased donors nationally. The Swedish model has also supported the introduction of DCD programs in Denmark, Iceland, and Finland.
Conclusions: Controlled DCD has been successfully integrated into Sweden’s national organ donation framework. Key success factors included national coordination, a structured pilot, interdisciplinary collaboration, and continuous training. With strong clinical outcomes and broad acceptance, the Swedish model now serves as a regional reference for DCD implementation in publicly funded healthcare systems. The next step is the national introduction of thoracoabdominal NRP (TA-NRP) to enable DCD heart transplantation.