Tuesday, June 14, 2011

Transplantation of lungs: recovered from donors after euthanasia

(openPR) - Donors after cardiac death (DCD) have increasingly provided organs for lung transplantation in Belgium. Between 01/2007-12/2009 in Leuven 17 isolated lung transplantations were performed from cardiac death donors, including four after euthanasia, Dirk van Raemdonck and colleagues (Leuven) report. "All donors expressed their wish for organ donation once their request for euthanasia was granted according to Belgian legislation. All donors suffered from an unbearable non-malignant disorder." One recipient died from a problem unrelated to the graft. The other three patients are still alive - in a good condition.

"The donors were admitted to the hospital a few hours before the planned euthanasia procedure. A central venous line was placed in a room adjacent to the operating room. Donors were heparinized immediately before a cocktail of drugs was given by the treating physician who agreed to perform the euthanasia.

The patient was announced dead on cardiorespiratory criteria by three independent physicians. The deceased was then rapidly transferred, installed on the operating table, and intubated. The thorax and abdomen were shaved, disinfected and draped. A rapid sterno-laparotomy was performed.

The abdominal team took care of liver and kidney preservation with a rapid flush cooling technique via a cannula inserted into the abdominal aorta. The thoracic team then opened pleural cavities and quickly inspected both lungs before topical cooling with ice-cold saline was started. The pericardium was opened, the main pulmonary artery was encircled,and a 24 Fr pulmoplegia catheter was inserted through the right ventricular outflow tract. The heart was decompressed and vented by cutting left and right atrial appendages. Antegrade pulmoplegia was started with 2.8L Perfadex solution while the lungs were ventilated with 50% inspired oxygen, followed by retrograde flush with one additional liter of the same perfusion solution after the heart was extracted.

Lungs were then explanted, packed and transported to the recipient hospital in the standard way..."

D. van Raemdonck et al. Initial Experience with Transplantation of Lungs Recovered from Donors after Euthanasia.
in: Weimar, Bos, Busschbach (Eds.) Organ Transplantation - Ethical, Legal and Psychosocial Aspects. Pabst, Lengerich/Berlin 2011, ISBN 978-3-89967-639-6

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