Donor cause of brain death and related time intervals: does it affect outcome after lung transplantation?☆☆☆

Wauters, Shana; Verleden, Geert M.; Belmans, Ann; Coosemans, Willy; Leyn, Paul De; Nafteux, Philippe; Lerut, Toni; Raemdonck, Dirk Van

doi:10.1016/j.ejcts.2010.11.049

Cited by 32 publications

(20 citation statements)

References 25 publications

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“…Similar results have been reported from Australia and Belgium [44,45]. The absence of these insults in the DCD donor and the ability of the lung to tolerate warm ischaemia may explain these similar outcomes [46,47]. The haemodynamic and inflammatory changes induced by brain stem death render only 20% of DBD lungs suitable for transplantation.…”

Section: Lungsupporting

confidence: 71%

Organ donation after circulatory death

Blackstock

Ray²

2014

European Journal of Emergency Medicine

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There is an ongoing shortfall of organs for donation in the UK and worldwide. Strategies including donation after circulatory death (DCD), living donation and better identification of potential donors are attempting to increase the number of donors and donated organs. The number of DCD donors in the UK increased by 808% from 37 to 336 between 2001 and 2010 and this is continuing to increase. The most common organs donated from DCD donors are the kidneys, but there is increasing experience of liver, lung and pancreas transplantation. The process of DCD varies between different countries and institutions. The outcome of DCD transplantation has been largely encouraging, particularly for kidneys. The increase in DCD has led to an appraisal of issues that may arise during the donation process; these include the Lazarus phenomenon, the dead donor rule, perimortem interventions, public opinion and conflict of interest for clinicians.

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Section: Lungsupporting

confidence: 71%

Organ donation after circulatory death

Blackstock

Ray²

2014

European Journal of Emergency Medicine

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“…Renal transplant outcomes are adversely affected by cerebrovascular causes of BD [54, 55]. Lung transplant is unaffected by donor cause of death [56], while heart transplant outcomes remain controversial [57, 58]. For this reason, it is important to consider the pathophysiologic responses to severe central nervous system injury, and their systemic sequelae, prior to brain death.…”

Section: Stage One Of Potential Organ Injury: Brain Injurymentioning

confidence: 99%

Inflammatory Signalling Associated with Brain Dead Organ Donation: From Brain Injury to Brain Stem Death and Posttransplant Ischaemia Reperfusion Injury

Watts

Thom

Fraser

2013

Journal of Transplantation

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Brain death is associated with dramatic and serious pathophysiologic changes that adversely affect both the quantity and quality of organs available for transplant. To fully optimise the donor pool necessitates a more complete understanding of the underlying pathophysiology of organ dysfunction associated with transplantation. These injurious processes are initially triggered by catastrophic brain injury and are further enhanced during both brain death and graft transplantation. The activated inflammatory systems then contribute to graft dysfunction in the recipient. Inflammatory mediators drive this process in concert with the innate and adaptive immune systems. Activation of deleterious immunological pathways in organ grafts occurs, priming them for further inflammation after engraftment. Finally, posttransplantation ischaemia reperfusion injury leads to further generation of inflammatory mediators and consequent activation of the recipient's immune system. Ongoing research has identified key mediators that contribute to the inflammatory milieu inherent in brain dead organ donation. This has seen the development of novel therapies that directly target the inflammatory cascade.

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“…By contrast, there are examples of long maintenance periods being associated with a greater number of transplanted organs/donor . Longer BDPDs were associated with a better PaO 2 /FiO 2 in the donor, an increased supply of lungs for transplantation, and improved function of hearts initially considered “non‐transplantable.” Muruve et al. found that both kidney grafts harvested in less than 24 hours and those explanted after 59.3 hours had better functional performance.…”

Section: Discussionmentioning

confidence: 99%