Strategies to increase limited donor resources

Abstract

A number of strategies have been advocated to increase the number of lung donors including: 1) improvement in donor resuscitation; 2) better methods of lung preservation; 3) extension of the lung donor selection criteria; 4) development of a living-related lung donor programme; and 5) utilisation of nonheart beating donors.Other strategies such as the split-lung technique and techniques of lung reduction to accommodate large lungs into a small-size recipient have also been used successfully. In this article, each of these strategies have been reviewed and some recommendations are suggested based on the authors9 own experience and that of the literature.

Brain death and its implications for management of the potential organ donor

“…100 In some cases, fluid resuscitation and dopamine administration is insufficient to restore cardiac afterload, and a vasopressor has to be added. Both norepinephrine 83,89,90 and vasopressin [101][102][103] are recommended, and excellent results have been obtained by both. Vasopressin is effective against diabetes insipidus, and it reduces the hemodynamic need for catecholamines.…”

“…If a vasopressor (norepinephrine, vasopressin, or epinephrine) has to be added for stabilizing hemodynamics, a device to measure CO and SVR is recommended. 6,83,98,103,113 The goals are to 'normalize' hemodynamic variables 6,83,98 and use of the pulmonary artery catheter (PAC) has been the gold standard, but transpulmonary thermodilution measurements or esophageal Doppler measurements (EDM) are good alternatives. 114 In addition to CO and SVR, transpulmonary thermodilution gives continuous CO by pulse contour analysis and estimates of intrathoracic blood volume (ITBV) and extravascular lung water (EVLW).…”

“…On the other hand, smoking history, age, positive Gram stain, number of days on ventilator, or localized abnormality on the chest radiograph may not be associated with increased perioperative risk, and should not by themselves preclude transplantation. 103,132 Organ procurement All the above strategies for donor management have to be continued during organ procurement to ensure optimal organ preservation and posttransplant function. The anesthesiologist of the harvesting team often plays a crucial role in assessing the adequacy of actual fluid resuscitation and vasoactive medication in use.…”

Organ utilization among deceased donors in Canada, 1993–2002

“…Similarly, the growth of lung transplant programs, spurred by significant improvements in organ preservation, donor management and surgical techniques, is evidenced by the dramatic increase in lung utilization rates. 4 The low intestinal utilization rate is an anticipated finding, given that intestinal and multivisceral transplant activity in Canada has been limited. The flat utilization pattern for hearts suggests that the aging donor pool has reduced the availability of hearts medically suitable for transplantation.…”

End points for pulmonary arterial hypertension: a way backward

“…In the June 2004 issue of the European Respiratory Journal, PEACOCK et al [1] recognised the need for end points, other than the assessment of functional capacity with the 6 min walking test, in pulmonary arterial hypertension (PAH) clinical trials. In their looking forward, the authors did not mention any role of the diffusing lung capacity for carbon monoxide (DL,CO) test, which was originally devised in 1909-1915 [2].…”