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

Pabst Science Publishers (Lengerich/Westfalia, Germany) is publishing ten psychological and nine medical journals; furthermore, Pabst is publishing more than hundred psychological and medical books per year – partly specialized scientific literature, partly specialist literature written for laypeople.

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Donation After Cardiac Death' Worsens Liver Transplant Survival

Medscape.com

NEW YORK (Reuters Health) - Liver transplant patients have significantly worse survival odds with grafts obtained after cardiac death instead of brain death, according to a study of U.S. data.

"Donation after cardiac death" (DCD) livers are known to have relatively poor graft survival, according to a February 19th report in the Journal of Hepatology, but studies of patient survival have only looked at small cohorts - until now.

Dr. Anton Skaro and colleagues from Northwestern University in Chicago analyzed national data from the Scientific Registry of Transplant Recipients on more than 43,000 liver transplants -- 1113 from DCD donors and 42,254 from brain death donors.

Patients who received DCD livers were generally older compared to the other patients, but they had fewer risk characteristics (lower MELD scores, less likely on life support, and less likely to be hospitalized) and more favorable transplant factors (younger donor age, shorter cold ischemia time, and lower rates of vasopressor use).

Despite these favorable features, 1- and 3-year patient survival rates were 82% and 71%, respectively, with DCD livers compared to 86% and 77% with livers obtained from after brain death (p<.0001 for survival after primary transplant).

 After adjusting for differences in donor and recipient factors, DCD recipients had a 44% higher mortality risk.

 "This increased hazard for mortality is similar in magnitude to the mortality risks of other well-known donor and recipient factors," the investigators note, including older donor age, older recipient age, and hepatitis C or hepatocellular carcinoma in the recipient.

 The mortality risks got worse, though, when DCD organs were combined with cold ischemia time greater than 12 hours (hazard ratio 1.81), shared organs (HR 1.69), hepatocellular carcinoma (HR 1.80), recipient age older than 60 (HR 1.92), and renal insufficiency (HR 1.82).

 But beggars can't be choosers.

 "Many of these patients may have not been offered a (brain death) liver, so survival results of 82% at one year and 71% at three years should be considered in light of the high mortality risks associated with remaining on the waiting list," the researchers say. "This is especially salient given that 30-day mortality is between 19% and 47% for patients with a MELD greater than 20."

 Retransplantation was required more than twice as often after DCD transplant (14.7% vs 6.8%; p<.001), but survival after retransplantation did not differ significantly according to the original graft source.

 SOURCE: http://www.bit.ly/i0pxTi

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Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Kidneys from cardiac-death patients perform as well as those from brain-dead patients

This news from the UK could mean more organs would be available for those who need them

Physorg.com

The number of people on the kidney transplant waiting list in the UK continues to increase with over 7000 patients currently waiting for transplant and only 1600 kidney transplants performed from deceased donors each year. Until recently, most donated kidneys came from donors who were brain dead—meaning people whose hearts were still beating but had suffered brain-stem death. However the number of these donors has fallen over the last decade, probably due to improvements in the treatment of head injuries and a reduction in deaths on the road. As a result there has been a corresponding surge in the number of cardiac-death donors (non-beating heart donors), rising from 3% of all donations in 2000 to 32% in 2009.

Concerns have been raised that kidneys transplanted from cardiac death donors do not perform as well as those from brain-dead donors; but an Article published Online First in The Lancet concludes that the two types of transplant are equivalent. Furthermore, cardiac-death donor kidneys, which fall outside of the UK's national allocation policy (they are currently distributed locally), should now be treated in the same way as kidneys from brain-dead donors.

Kidneys donated in either fashion acquire some degree of injury—for brain-death, there are substantial hormonal and metabolic changes, while for cardiac-death the kidneys suffer warm ischaemia (injury caused when the organs are deprived of a blood supply, before being cooled to minimise the damage) between the heart stopping and the kidneys being flushed with cold preservation solution. In the UK, most cardiac-death donors are controlled donors, who have suffered massive irreversible brain injury but do not fulfil the criteria for brain-stem death. Death is certified by when the heart stops beating after a decision to withdraw life support.

In this study, Professor J Andrew Bradley, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK, and colleagues looked at outcomes for kidneys after controlled cardiac death versus brain death, and aimed to identify factors affecting graft survival and function. They used data from the UK transplant registry to select a cohort of deceased kidney donors and the corresponding transplant recipients (aged ≥18 years) for transplants done between Jan 1, 2000, and Dec 31, 2007.

A total of 9134 kidney transplants were done in 23 centres; 8289 kidneys were donated after brain death and 845 after controlled cardiac death. First-time recipients of kidneys from cardiac-death donors (n=739) or brain-death donors (n=6759) showed no difference in graft survival up to 5 years, or in kidney function (filtration rate) at 1 to 5 years after transplantation. For recipients of kidneys from cardiac-death donors, increasing age of donor and recipient, repeat transplantation, and cold ischaemic time of more than 12 h were associated with worse graft survival; grafts from cardiac-death donors that were poorly matched for HLA (a blood antigen) had a non-statistically significant association with inferior outcome, and delayed graft function and warm ischaemic time had no effect on outcome.

The authors say: "The shortage of donor organs remains one of the key challenges faced by the international transplant community. In view of our findings, cardiac-death donors represent an extremely important and overlooked source of high-quality donor kidneys for transplantation and have the potential to increase markedly the number of kidney transplants performed in the UK."

They also point out that allocation policy for kidneys from brain-death donors aims to ensure equity of access to donor kidneys irrespective of the geographical location of those on the waiting list, to ensure good tissue matching for those in whom it matters most, to favour those who have waited longest, and to avoid large disparities in age between donor and recipient. In view of their findings, the authors suggest that a similar policy should be considered for kidneys from cardiac-death donors, ie, the findings strengthen the case for a national sharing scheme. (See notes to editors below).

They conclude: "Kidneys from controlled cardiac-death donors provide a good outcome in terms of both graft survival and graft function in first-time recipients and should be regarded as equivalent to kidneys from brain-death donors. The factors shown to affect transplant outcome for kidneys from cardiac-death donors will help to guide clinical decision-making and inform future allocation policy."

In an accompanying comment, Professor Sir Peter J Morris, Centre for Evidence in Transplantation, Royal College of Surgeons of England and London School of Hygiene and Tropical Medicine, London, UK, says: "Today's report is an important contribution to the problem of increasing the supply of donor kidneys for transplantation. The results are persuasive that the use of controlled cardiac-death donors is an acceptable practice. More importantly, potential recipients of kidneys from cardiac-death donors can be reassured that their transplant outcome is not jeopardized by the source of the kidney."
Provided by Lancet

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Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network. NEW for Ontario: recycleMe.org - Learn The Ins & Outs Of Organ And Tissue Donation. Register Today! For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help 75 to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

LANDMARK NUMBER OF ORGAN DONORS AFTER CARDIAC DEATH IN ONTARIO

Ontario leads Canada with more than 100 donations after cardiac death

Toronto, ON – Ontario is the nation’s leader in organ Donation After Cardiac Death (DCD). Trillium Gift of Life Network (TGLN) announced the landmark achievement of more than 100 DCD cases performed in 22 hospitals in Ontario.

“As a direct result of 100 cases of DCD, 246 lives were saved through the transplantation of lungs, livers, kidneys and pancreases. As well, 63 per cent of the DCD cases also resulted in donated tissue including bones, eyes, heart valves and skin,” said Frank Markel, President and CEO of TGLN. “DCD is a proven best practice to improve donation performance and has contributed to Ontario’s record success in saving lives. Without the collaboration and strong support of many hospitals and physicians, this improvement would not be possible.”

Historically transplantation of organs and tissue from deceased donors was first done after a person’s death had been determined by cardiac criteria – when their hearts had stopped beating. Later, determination of death for organ and tissue donation purposes was done according to strict neurological criteria (brain death). This became the only accepted determination of death before the first DCD case in Canada in the modern era was performed when Emile and Beth Therien made the decision to remove their daughter, Sarah Beth, from life support. The Therien family wanted to honor Sarah Beth’s wishes to be an organ donor.

"Sarah Beth's legacy as an organ and tissue donor and the wonderful memories we have of her will always sustain us during very difficult times. In death, Sarah Beth became a medical pioneer. For the first time in Canada,in the modern era, cardiac death, not brain death, was the criterion for allowing transplants. We are further consoled knowing that since that historic medical breakthrough at the Ottawa Hospital on June 17, 2006 many more lives have been saved. My family's experience as a donor family really speaks to the importance of the responsibility that health care systems have to honor families’ requests, particularly with donation after cardiac death, as it serves the public good," said the Theriens.

DCD offers families the option of donation in cases where neurological criteria for death have not been met. DCD is carried out only after a prior and independent decision by the family and treating physician has been made to withdraw life-sustaining treatment.DCD follows pronouncement of death, and is based on “irreversible cessation of circulatory and respiratory function.”

Today in Ontario, 17 per cent of deceased organ donations are a result of DCD, while brain death accounts for 83 per cent. Ontario ranks in the upper quartile for percent of DCD cases among the organ procurement organizations in the United States.

“DCD in Ontario has truly been a remarkable improvement. Lives have been saved through a better organized system. People in Ontario really value the gift of life, and now we are in a better position to help them give that gift,” said Dr. Andrew Baker, Chief of Critical Care at St. Michael’s Hospital.

For a list of Ontario the centers that contributed to the increase in deceased organ donations read the backgrounder

DCD is an opportunity for families to support the wishes of their loved ones to save and enhance more lives at the end of life. TGLN encourages Ontarians to register their consent to donate organs and tissue and talk to their families about their wishes.

In Ontario, you can register your consent to donate your organs and tissue by going to the TGLN web site below or by visiting your local ServiceOntario Health Card Services – OHIP office or outreach center where you renew your health card.

“You Have the Power to Save Lives – Register to be an organ and tissue donor & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network. NEW for Ontario: recycleMe.org - Learn The Ins & Outs Of Organ And Tissue Donation. Register Today! For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants (see allotransplantation). One tissue donor can help 75 to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant. Organs can save lives, corneas renew vision, and tissue may help to restore someone's ability to walk, run or move freely without pain. Life Begins with You

Mayo Clinic Reports its First Lung Transplantation by Donation After Cardiac Death

Thursday, February 18, 2010
News Release
ROCHESTER, Minn. — Lung transplantation is a well-known therapy for patients with end-stage lung disease, but, as with other patients waiting for organs for transplantation, there are more recipients waiting than donors available. A potential solution for patients with end-stage lung disease is donation after cardiac death (DCD). Mayo Clinic reports its — and Minnesota's — first lung transplantation from DCD in the February issue of Mayo Clinic Proceedings.

VIDEO ALERT: Additional audio and video resources including excerpts from an interview with Dr.Cassivi, describing the research are available on the Mayo Clinic News Blog. Please see the end of the release for details.

While brain death has become the most widely used criteria for organ donation over the past few decades, the earliest organ donations were from deceased donors following cardiac death, says Stephen Cassivi, M.D., Mayo Clinic thoracic surgeon and lead study author. "Today, our critical shortage of organs has brought about renewed interest in DCD organ procurement," he says. Few centers across the country perform DCD organ procurement for lung transplantation, and until recently only about 60 procedures have been done in the United States.

Mayo's first DCD lung transplantation was performed a year ago in a 59-year-old Illinois man who had alpha-1antitrypsin deficiency — an inherited condition associated with emphysema. Emphysema is a type of chronic obstructive pulmonary disease, which includes a group of conditions that block airflow and make breathing difficult. He also was a former tobacco user.

Almost one year after his transplant, the recipient says he is doing well, walking about three or four miles a day. "I would not have made it through 2009 without the transplant, and today I am feeling better than I have in years and am able to be with my family," he says. "I feel very lucky and am grateful to my donor and his family."

Before his transplant, the patient's forced expiratory volume in the first second (FEV1) — a measure of lung function and the ability to breathe — was at 20 percent of normal, but at his appointment in January 2010, his FEV1 was at 103 percent, beyond normal, according to Dr. Cassivi. "He has made the absolute most of this gift," Dr. Cassivi says. "He's no longer confined to just sitting around. He is working his lungs and getting back to enjoying his life and the ability to breathe normally."

Transplantation made possible by DCD donors — individuals who are declared dead according to criteria recommended in the Uniform Declaration of Death Act in the early 1980s — expands the number of potential organs available to patients who desperately need organ transplants to live, Dr. Cassivi says. "As with our first patient in this report, we see this form of transplantation as a further needed opportunity to turn the inevitable tragedy for the donor and his or her loved ones into hope and life for transplant recipients," he says.

A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at http://www.mayoclinicproceedings.com.

“You Have the Power to Save Lives – Register to be an organ and tissue donor & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network. NEW for Ontario: recycleMe.org - Learn The Ins & Outs Of Organ And Tissue Donation. Register Today! For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

Has your life been saved by an organ transplant? "Pay it forward" and help spread the word about the need for organ donation - In the U.S. another person is added to the national transplant waiting list every 11 minutes and 18 people die each day waiting for an organ or tissue transplant.