Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death

Abstract

We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8 minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8 minutes (SD 16.8).Preservation time was 159 minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8 years (SD 3.1), and mean total ischemic time was 678 minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52 months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes. K E Y W O R D Sclinical research/practice, donation after circulatory death (DCD), donors and donation, lung transplantation/pulmonology, organ perfusion and preservation, organ procurement, organ procurement and allocation, transplant coordinator

Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation—First comparison with brain death donors

“…ischemic times was very short (77-94 minutes), with a first month and one-year survival rates of 100% and 80%, respectively. Suberviola et al38 , also from the Santander group, recently reported a 5-year survival rate of 87.5% with lungs obtained from uDCD in a short series of eight lung transplants. The authors emphasized that a program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.…”

“…Abbreviations: AR, acute rejection; BDD, brain dead donors; BMI, body mass index; ECLS, extracorporeal life support; NIMV, non-invasive mechanical ventilation; PGD G3, primary graft dysfunction grade 3; SPH, secondary pulmonary hypertension; uDCD, uncontrolled non-heart-beating donors.Type of donor comparing overall mortality in the uDCD group vs. overall mortality in BDD.Suberviola et al38 , also from the Santander group, recently reported a 5-year survival rate of 87.5% with lungs obtained from uDCD in a short series of eight lung transplants. Abbreviations: AR, acute rejection; BDD, brain dead donors; BMI, body mass index; ECLS, extracorporeal life support; NIMV, non-invasive mechanical ventilation; PGD G3, primary graft dysfunction grade 3; SPH, secondary pulmonary hypertension; uDCD, uncontrolled non-heart-beating donors.Type of donor comparing overall mortality in the uDCD group vs. overall mortality in BDD.Suberviola et al38 , also from the Santander group, recently reported a 5-year survival rate of 87.5% with lungs obtained from uDCD in a short series of eight lung transplants.…”

The unique moral permissibility of uncontrolled lung donation after circulatory death

“…[2][3][4] Given the potential for saving lives, why has lung uDCDD not been widely utilized throughout the United States? [2][3][4] Given the potential for saving lives, why has lung uDCDD not been widely utilized throughout the United States?…”

“…donors and donation: donation after circulatory death (DCD), donors and donation: extended criteria, editorial/personal viewpoint, ethics and public policy, lung transplantation/ pulmonology, organ procurement, organ procurement and allocation achieving results similar to BDD. [2][3][4] Given the potential for saving lives, why has lung uDCDD not been widely utilized throughout the United States? Part of the reason stems from earlier unsuccessful uDCDD efforts.…”

“…However, newer techniques for initial uDCDD lung preservation are notably non-invasive when compared to what are now standard procedures for preserving lungs and other organs, thus respecting the body and preserving bodily integrity. Use of non-invasive initial preservation measures would enable uDCDD lung preservation to work within ethical norms in the United States, provided an understanding that the family can still subsequently decide not to donate.Instead of inserting chest tubes for cold in situ perfusion,3,4,17 recent uDCDD lung protocols advocate using post mortem mechanical ventilation for initial lung preservation 9,18. Novel controlled DCDD protocols, translated from animal models, recently have preserved lungs for up to 3 hours after circulatory-respiratory arrest using positive end expiratory pressure (PEEP) to partially inflate the lungs without ventilation, with improvement in function by placing the body in prone positioning 19,20.…”