Organ Preservation

Abstract

Organ preservation is the supply line for organ transplantation. Currently, the liver, pancreas, and kidney can be successfully preserved for up to two days by flushing the organs with the University of Wisconsin (UW) organ preservation solution and storing them at hypothermia (0-5 degree C). The UW solution is effective because it uses a number of cell impermeant agents (lactobionic acid, raffinose, hydroxyethyl starch) that prevent the cells from swelling during cold ischemic storage. Additionally, the UW solution contains glutathione and adenosine, agents that may stimulate recovery of normal metabolism upon reperfusion by augmenting the antioxidant capacity of the organs (glutathione) or by stimulating high-energy phosphate generation (adenosine) upon reperfusion. Although this method of organ preservation is effective, some organs (5-15% of livers and 20-30% of kidneys) do not function well upon transplant. Injury may be preservation related but may also result from donor and recipient factors that render the organs more susceptible to preservation damage. Results with continuous perfusion of kidneys in the clinics show a reduction in preservation/reperfusion damage. This may be a more appropriate preservation method than cold storage. In this chapter we discuss the development and use of the UW solution and present clinical results. Although intraabdominal organs are well preserved at present, intrathoracic organs (lungs and heart) are less well preserved, and better methods for preservation of these organs are needed for increased use of lung and heart transplantation.

Cadaveric bone marrow and spleen cells for transplantation

“…Around 70% of those approached gave consent. University of Wisconsin (UW) solution 16 was used for organ preservation in all cases. The median age of the donors was 47 years with a range between 4-67 years (nine males and 11 females).…”

Cryopreservation

“…44 The concept of specialty preservation media has evolved out of the organ preservation specialties. The Belzer and Southard team 15,16 first developed ViaSpan ® (the University of Wisconsin solution) to support the transport of organs (pancreas, kidney and liver). ViaSpan ® , formulated for hypothermic storage, was the first solution designed to manage select putative stress factors ( Table 1) and became the first "intracellular-like" preservation medium.…”

“…Advances in the hypothermic storage research have depended on improvements in organ preservation media in support of cell and tissue storage and organ transplantation including those factors related to ion balance, buffering capacity, free radical scavenging, oncotic support and nutrients. [15][16][17] Cryopreservation may be defined as the maintenance of biologics at sub-freezing temperatures, below -80°C and typically below -140°C. As stated above, Mazur's "two-factor hypothesis" established the principles and a priori evidence of lethal conditions that need to be avoided if successful structural preservation is to be accomplished, a supposition influenced by Lovelock's classic demonstration of the relationship between survival and sodium chloride content in human RBCs.…”

Air transportation of patients with end-stage liver disease to distant liver transplantation centers

“…In this context it should be mentioned that transportation of harvested livers over relatively long distances using the University of Wisconsin solution is already possible for a number of years but is dependant on the existence of local expertise regarding transplantation setting. 26 The estimated annual local need for liver transplantation in Israel was assessed by Modan et al 4 to be approximately 100 cadaveric organs for a population of 6 million (not taking into account split liver technology or LRLT). Currently the local procurement system provides less than 50% of the estimated requirements, mainly through cadaveric whole organ donation (or split organs) and a small number of LRLTs.…”

“…Thus, local hepatologists and surgeons are frequently faced with almost impossible situations where despite the availability of three transplant centers, it is often impossible to save the life of a patient with fulminant liver disease or primary graft failure. [17][18][19][20][21][22][23][24][25][26][27][28][29] Our practice to send patients who require emergency liver transplantation abroad has been criticized in Israel. Those who oppose it claim that the availability of organs abroad, although very limited, undermines the ability to convince a patient's family members to agree to LRLT and suggest that the health authorities should discontinue reimbursement for LTX.…”