Ischemia-reperfusion injury
Lung Procurement for Transplantation: New Criteria for Lung Donor Selection

https://doi.org/10.1016/j.transproceed.2010.03.103Get rights and content

Abstract

In Italy, like everywhere in the world, the organ shortage for transplantation is a real problem. It is well known that lung donors (LD) are particularly difficult to procure and that management of the organ do not care during the diagnosis of cerebral death represents a difficult challenge. In this context, the salvage of the so-called “marginal donors” may increase the pool of donors, favoring organ retrieval. To increase lung procurement, the intensivist must recognize “marginal donors,” optimizing organ selection and function. The aim of our study was to review LD procured in 2008, as identified by the unrestricted criteria, of the Nord Italian Transplant program Center (NITp). Particularly, the age and habits of donors and the presence of a parenchyma contusion were not sufficient per se to exclude donation. We revisited lung ventilation and monitoring modalities during cerebral death before retrieval. In 2008, the application of enlarged criteria for LD enabled us to collect 21 LD, namely 33% of all cerebral deaths, versus 13% in 2007. Seeking to maintain good gas exchange and lung function, we implemented a safe ventilation program avoided high peak pressures, and fluid therapy properly guided by the cardiac index and extravascular lung water index monitoring. Specific actions to improve LD procurement may help cope with the organ-donor shortage. Although our series was small, our results were encouraging; they underline the necessity to continuously review donor criteria and care, allowing good donor/recipient matching.

Section snippets

Materials and Methods

Via a collaborative study with the NITp, the regional center for organ and tissue validation and allocation, we presented new selective criteria for LD, which were adopted by the transplant coordinator A.O. Niguarda Cà Granda. Brain death diagnosed in the neurological intensive care unit allowed organs donors to be identified for transplantation.

The criteria to exclude lung retrieval were limited to: general exclusion donor criteria,6 documented lung inhalation, PaO2/FiO2 < 250 (FiO2 1.0), and

Results

Among 31 cerebral deaths in 2008, we selected seven LD. Cerebral death was caused by vascular disease (n = 4) posttraumatic lesions (n = 2), or secondary to a postanoxic cerebral damage (n = 1; Table 1). The procured lungs were all transplanted; primary organ function was achieved in five recipients, nonfunction due to reperfusion damage, as reported by the surgeons in two cases.

Donor age was distributed over a wide range: over the age of 50 years (n = 3) or over 55 years old (n = 2) (Table 2).

Discussion

New exclusion criteria adopted for LD selection were reduced to a minimum, albeit in agreement with safety considerations. This strategy was adopted to meet the organ shortage that is particularly severe for LD. We sought to apply these criteria to collect a donor pool as largest as possible. The criteria we used for LD were effective to increase lung procurement to a positive trend in 2008 compared with 2007. All selected lungs were used for transplantation. Primary organ function, although a

References (10)

There are more references available in the full text version of this article.

Cited by (0)

View full text