Lung donation after medical assistance in dying at home

Healey, Andrew; Cypel, Marcelo; Pyle, Helen; Mills, Caitlin; Heffren, Jodie; Katz, David R.; Smith, Justin; Teranishi, Robert T.; Lavery, Susan; Beitel, Janice; MacLean, Janet; Prodger, Dwight; Keshavjee, S.; Yeung, Jonathan C.

doi:10.1111/ajt.16267

Cited by 17 publications

(51 citation statements)

References 9 publications

(20 reference statements)

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“…Based on our experience with controlled DCD and uncontrolled DCD transplantation, using the same principles, we were able to devise a protocol for proper lung preservation after death declaration so that the donor could be transported to nearest hospital for organ retrieval to take place. 8 When we initiated this practice, we adopted a conservative practice by evaluating the function of these MAID donor lungs in all cases using EVLP. As we acquired further experience and confidence in our assessment process, we moved to a protocol of using EVLP when there are concerns in the on-site donor assessment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of lung transplantation from organ donation after medical assistance in dying: First North American experience

Watanabe

Kawashima

Kohno

et al. 2022

American Journal of Transplantation

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Section: Discussionmentioning

confidence: 99%

“…The logistic details of MAID provision at home were described in a recent case report. 8 Briefly, MAID and the offer of lung donation were requested voluntarily. MAID drugs were given by clinicians at home.…”

Section: Maid Indication Consent and Proceduresmentioning

confidence: 99%

Outcomes of lung transplantation from organ donation after medical assistance in dying: First North American experience

Watanabe

Kawashima

Kohno

et al. 2022

American Journal of Transplantation

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“…These donors have not underwent brain death nor associated cytokine storm 9 , which have a negative impact on isolation yield and in vivo function 10 . DCD V lung recipients showed good early graft function 33 , even when the procedure is initiated outside the hospital 34 . A recent study reported equal short- and long-term outcome as for DCD III and DBD 35 .…”

Section: Discussionmentioning

confidence: 99%

Utility of Islet Cell Preparations From Donor Pancreases After Euthanasia

et al. 2022

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Patients fulfilling criteria for euthanasia can choose to donate their organs after circulatory death [donors after euthanasia (DCD V)]. This study assesses the outcome of islet cell isolation from DCD V pancreases. A procedure for DCD V procurement provided 13 pancreases preserved in Institut Georges Lopez-1 preservation solution and following acirculatory warm ischemia time under 10 minutes. Islet cell isolation outcomes are compared with those from reference donors after brain death (DBD, n = 234) and a cohort of donors after controlled circulatory death (DCD III, n = 29) procured under the same conditions. Islet cell isolation from DCD V organs resulted in better in vitro outcome than for selected DCD III or reference DBD organs. A 50% higher average beta cell number before and after culture and a higher average beta cell purity (35% vs 24% and 25%) was observed, which led to more frequent selection for our clinical protocol (77% of isolates vs 50%). The functional capacity of a DCD V islet cell preparation was illustrated by its in vivo effect following intraportal transplantation in a type 1 diabetes patient: injection of 2 million beta cells/kg body weight (1,900 IEQ/kg body weight) at 39% insulin purity resulted in an implant with functional beta cell mass that represented 30% of that in non-diabetic controls. In conclusion, this study describes procurement and preservation conditions for donor organs after euthanasia, which allow preparation of cultured islet cells, that more frequently meet criteria for clinical use than those from DBD or DCD III organs.

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“…We have described the successful technique for MAID donation with death at home followed by LTx. 49 This type case requires additional logistical organization to maximize preservation of the lung, including transportation of the intubated donor in a prone position with passive lung inflation and ready operating room (OR) resources. However, at first discussion and to ultimately help as many recipients as possible, it is important to continue to offer admission to hospital which allows for multiorgan donation from a MAID donor.…”

Section: Controlled and Uncontrolled Donation After Cardiac Deathmentioning

confidence: 99%

Pushing the Envelope for Donor Lungs

Abdelnour‐Berchtold

Cypel

Keshavjee

2021

Semin Respir Crit Care Med

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The shortage of organ donors remains the major limiting factor in lung transplant, with the number of patients on the waiting list largely exceeding the number of available organ donors. Another issue is the low utilization rate seen in some types of donors. Therefore, novel strategies are continuously being explored to increase the donor pool. Advanced age, smoking history, positive serologies, and size mismatch are common criteria that decrease the rate of use when it comes to organ utilization. Questioning these limitations is one of the purposes of this review. Challenging these limitations by adapting novel donor management strategies could help to increase the rate of suitable lungs for transplantation while still maintaining good outcomes. A second goal is to present the latest advances in organ donation after controlled and uncontrolled cardiac death, and also on how to improve these lungs on ex vivo platforms for assessment and future specific therapies. Finally, pushing the limit of the donor envelope also means reviewing some of the recent improvements made in lung preservation itself, as well as upcoming experimental research fields. In summary, donor lung optimization refers to a global care strategy to increase the total numbers of available allografts, and preserve or improve organ quality without paying the price of early-, mid-, or long-term negative outcomes after transplantation.

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Lung donation after medical assistance in dying at home

Cited by 17 publications

References 9 publications

Outcomes of lung transplantation from organ donation after medical assistance in dying: First North American experience

Outcomes of lung transplantation from organ donation after medical assistance in dying: First North American experience

Utility of Islet Cell Preparations From Donor Pancreases After Euthanasia

Pushing the Envelope for Donor Lungs

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