Organ donation: when should we consider intestinal donation

Abstract

Summary Although more than 2300 intestinal transplantations (IT) have been performed worldwide, a description of intestinal donor criteria is still missing. This causes confusion among transplant coordinators, OPOs, physicians at intensive care unit and transplant surgeons. A Med‐line search looking for publications about donor criteria or donor selection in human IT was performed in December 2011. Retrospective analysis of 39 deceased donors from whom, in the period January 2006–December 2011, 20 isolated intestinal grafts and 19 multivisceral grafts were recovered and successfully transplanted. Review of the Literature: Among 3504 publications about IT, no study reported specifically about intestinal donor profile. The most commonly cited donor criterion was age, while all other criteria were inconsistently discussed. Based on the collected data, we suggest following inclusion criteria for donation of IT grafts: age 0–50 years, ICU‐stay <1 week, no blunt abdominal trauma, most recent Sodium <155 mmol/l, no severe ongoing transfusion requirements, standard donor therapy including early enteral nutrition and a compatible donor–recipient size match. By providing simple criteria for intestinal donation from deceased donor, we may help to properly utilize the limited donor pool.

Donor Characteristics of Intestinal Graft in Turkey

“…According to a comprehensive review including 3504 publications about intestinal transplantations; any of published studies had not specifically reported the donor characteristics (5) . The most mentioned donor criteria was donor age.…”

Intestinal transplantation: The anesthesia perspective

“…However, no histological differences were observed in grafts with more and less than 9 h of CIT, therefore the 9-h cut-off cold ischemia time is debatable [13]. Studies have shown that use of short-term pressors in unstable donors does not exclude intestinal donation [18]. However, use of high dose of vasopressors such as N 10 mg/kg/min of dopamine or epinephrine during donor operation worsened 3-month survival [18].…”

“…Studies have shown that use of short-term pressors in unstable donors does not exclude intestinal donation [18]. However, use of high dose of vasopressors such as N 10 mg/kg/min of dopamine or epinephrine during donor operation worsened 3-month survival [18].…”

A novel histidine–tryptophan–ketoglutarate formulation ameliorates intestinal injury in a cold storage and ex vivo warm oxygenated reperfusion model in rats

“…The current preservation strategy for intestinal grafts consisting of vascular perfusion followed by static cold storage (CS) with University of Wisconsin solution (UW) has not changed for decades and is still the gold standard [6,7]. Histidine-tryptophan-ketoglutarate (HTK) solution, an extracellular type and low-viscosity solution with a relatively low potassium concentration was postulated superior in maintaining intestinal viability [2] and has been increasingly administered in clinical application [6,8,9]. Yet, the difference of preservation outcome between UW and HTK is still controversial and no evidence has been found which hints significant advantage of HTK in terms of histological and functional assessment [6,7,10].…”