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

Abstract

Uncontrolled donation after cardiac death is an appealing source of organs for lung transplantation. We compare early and long-term outcomes of lung transplantation with these donors with a cohort of transplants from brain death donors at our institution. Retrospective analysis of all lung transplantations was performed from 2002 to 2012. We collected variables regarding recipients, donors, recover and transplant procedures, early and late complications, and survival. We included 292 lung transplants from brain death donors and 38 from uncontrolled donors after cardiac death.Both groups were comparable except for sex mismatch (male recipient-female donor was more frequent in the brain death cohort, 17.8% vs 0%, P 0.002), total ischemic time (longer for donors after cardiac death, 657 minutes for the first lung and 822 minutes for the second vs 309 and 425 minutes, P < 0.001), and ex vivo evalua-

Initial lung transplantation experience with uncontrolled donation after cardiac death in North America

“…Although a fairly large experience with cDCD donation for lung transplant has been achieved and demonstrated outcomes at least comparable to DBD, the experience with uncontrolled DCD has been small and mostly from centers in Spain with a case report from Italy . In the Spanish protocol, typically, the potential donor is transported to the hospital where death is certified after cardiac massage is interrupted; chest compressions are resumed to preserve the opportunity for donation.…”

“…Importantly, patient outcomes have been comparable to those of patients receiving organs from brain death donors (DBDs) . However, the use of uncontrolled DCD (uDCD) (Maastricht categories 1‐2) for lung transplant has been limited to a few series of cases from Spain and Italy, and there have been no reports in North America with the exception of 1 case from a consented cDCD from a patient who had a cardiac arrest before the planned organ recovery procedure . Further, Egan and colleagues described the potential, but also the challenges, associated with uDCD practices in North America; however, no actual transplants were performed in this report.…”

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.…”