Lung Transplantation from Nonheparinized Category III Non-Heart-Beating Donors. A Single-Centre Report

Abstract

Category III NHB lung donation is a good alternative in addition to HB lung donation. Using nonheparinized category III NHB donors and standard ante- and retrograde, flush perfusion resulted in good lung graft function and survival. NHB donation offers a great opportunity to reduce the burden of donor lung shortage.

Donors after cardiocirculatory death and lung transplantation

“…Tolerable WIT, defined as the time between cardiac arrest and cold flush, is around 30 minutes (5,7,(10)(11)(12)17,(19)(20)(21)(22)(23)(24)(25)(26)28,59,60,63,64). However, based on experimental data WIT of 60 minutes is tolerable (1,7).…”

“…Although there is not a consensus about the optimal time period among the centers, this period varies from 30 to 180 minutes (17,(19)(20)(21)23,25,26,59,60,63,64). Most of the centers are allowing maximum time of 90 minutes.…”

“…There are some centers that use pre-mortem heparin in a potential DCD donor (17,20,23,24,28,60,63). However some centers do not use premortem heparin (19,21,26,59).…”

“…The Toronto Group modified this method and published their results in nine cDCD donors (66). Selective use of EVLP is a part of the DCD Program in most centers (20,59,66).…”

“…Lung protective ventilation that reduces lung injury (i.e., a tidal volume of 6-8 mL/kg ideal body weight, with PEEP of 8 cmH 2 O, frequent suctioning) is recommended (7). A pre-mortem bronchoscopy is generally performed among the centers (17,21,23,59,60) to assess the airways and the placement of a nasogastric tube to prevent aspiration of gastric contents (17,59). The airways of a potential DCD donor might be protected from aspiration by omitting extubation; on the other hand, it might prolong the agonal phase by preventing collapse of upper airway of the potential donor (7).…”